Student Participant Guide Disaster Services

Student Participant Guide Disaster Services Disaster Health and Sheltering Course and Tabletop COURSE PURPOSE The Disaster Health and Sheltering Course acquaints pre-licensure nursing students with the role of nurses in disaster relief operations, especially in the shelter environment. This course provides familiarization with American Red Cross disaster health services response in a two-part curriculum. Although the course is designed for nursing students, it can also be used to orient Red Cross partners (e.g., Medical Reserve Corps or public health nurses) to shelter operations in the communities where they are located. COURSE OBJECTIVES After completing this course, nursing students will be able to: 1. Describe the role of the Red Cross Disaster Health Services (HS) volunteer in the disaster shelter setting. 2. Identify HS commitments as a Red Cross HS worker. 3. Describe HS disaster relief settings where volunteers may be assigned. 4. Assess disaster client needs, providing appropriate nursing care and client referral. 5. Describe possible challenges of working with the community after a disaster incident, to include strategies for providing assistance to individuals with functional and access needs. 6. Explain how HS align with public health nursing practice. COURSE DESCRIPTION Disaster Health and Sheltering is an introductory two-part course: Part I Independent Study accessed online and Part II In-Classroom Tabletop Exercise. It is designed to orient pre-licensure nursing students to the roles and responsibilities of a Disaster Health 1

Services (HS) volunteer. Nursing students may work under the supervision of a Red Cross Registered Nurse to meet the disaster-related health needs of clients (e.g., HS Student Caregiver.) The Disaster Health and Sheltering Course contains a total of four (4) hours of instruction in two parts. Completion of the entire course is required for the certificate of completion. Part I: Online Presentation (a narrated PowerPoint with case studies and a separate video on Red Cross history). Part I can be assigned as independent study or presented in the classroom by instructor. It provides an overview of the Red Cross Disaster Health Services activity using interactive content (2 hours). Part II: In-Classroom Tabletop Exercise in partnership with a Red Cross nurse instructor. A tabletop exercise, case studies and class discussion are used to reinforce disaster health principles and the nurse s role in addressing community health problems (2 hours). The Disaster Health and Sheltering Course is based upon the following assumptions: 1. Disaster preparedness is a critical component of the professional development of nursing students, especially post 9/11/01. 2. The American Association of Colleges of Nursing (AACN) requires emergency preparedness/disaster management content in all baccalaureate nursing programs for accreditation purposes. 3. Nursing students are encouraged to possess a strong community service record, motivating participation in learning activities that enables them to better serve. 4. Nursing programs may have limited time and resources in their curricula to offer the standard full-length Health Services Response Workshop (HSRW). 5. After taking this course, nursing students will gain awareness of how to serve as a volunteer with their community Red Cross Chapter. If not choosing this route of service, they will be better prepared to serve as a spontaneous volunteer during disaster. This course is divided into two parts: Disaster Health and Sheltering PowerPoint and Lecture In-Classroom Tabletop Exercise COURSE SCHEDULE AND REGISTRATION This course contains four (4) hours of instruction in two parts: Two (2) hours independent study online and two (2) hours in classroom as a tabletop exercise. Completion of the entire course is required for the course certificate of completion. If 2

you need assistance with registration or any of the materials, please contact your instructor. PART I: Narrated PowerPoint and Red Cross Historical Video Part I of the course is housed with the Disaster Resistant Communities Group (DRCG) LLC. Participants (both instructors and students) will self-register into a 2-hour online self-study component after obtaining enrollment information from their instructor. The instructor registers for class registration and tracking purposes. Participants complete a post-test and present this completion proof to your program instructor. COURSE ENTRY IS THROUGH: http://www.disasterhealthandsheltering.org After completion of Part I, students who are taking the online portion of Disaster Health and Sheltering will complete a post-test and print out the results of that post-test for proof of course completion. Upon course completion, a link to the post-test is found on the DRCG site. PART II: Tabletop Exercise NOTE: During Part I you should have printed out your Post-test answers as proof of completion for that portion of the course. Please ensure that you bring this print-out to your instructor on the day of class. Also, you will be joined in the classroom by a Red Cross nurse from the local chapter. This individual may or may not provide instruction but will be available for questions and direction re: Red Cross operations in disaster. EXERCISE SCHEDULE The date and time for the Operation Shelter Care Tabletop Exercise has been scheduled by your nursing instructor. EXERCISE DELIVERY SYSTEM - This exercise will be facilitated via an internet based application entitled ON-Line exercise (ONX) System which will allow instructor and students to participate in the exercise from their classroom. Information on the ONX System can be found at ONXSystem.com. EXERCISE PARTICIPATION On the day of the exercise you will participate from your classroom along with fellow nursing students. You will participate in the exercise with peers as a single Disaster Health Services Team assigned to a General Population Shelter. EXERCISE DURATION The exercise is designed as a class-paced learning opportunity that should take between an hour to an hour and a half to complete. EXERCISE START On the day of the exercise access www.onxsystem.com approximately 10 minutes before the scheduled start time, then login using your USER 3

NAME and PASSWORD. Once you have logged in click on the Operation Shelter Care Tabletop Exercise listed under the header Your Exercises in the upper left hand corner. Once you and your team are ready to begin the exercise, simply click on the forward arrow to move into exercise play. EXERCISE HELP DESK If you need assistance anytime during the exercise please call the Help Desk at: Phone Number 724-444-7444 Account Number 79799 # Identification Number 1 # COMPLETION OF PART II AND CERTIFICATE ISSUED - Upon completion of the classroom Tabletop Exercise you will be required to individually log back into the ONX system and complete the course evaluation (also known as the Hotwash). Approximately 2 days following the course you will receive an individual evaluation to complete. You MUST complete this evaluation within 48 hours in order to have the Disaster Health and Sheltering Certification of Completion issued to you. POST-COURSE FOLLOW-UP At the end of three months, or thereabout, you will receive a survey from the American Red Cross delivered to your email that you provided with your original registration (please use your permanent e-mail address). We hope that you will take the time (about 10 minutes) to complete this survey and tell us what impact this course may have had in your willingness to volunteer in disaster response. PARTICIPANT S WORKBOOK The following is a guide for the student to follow along the first part of the web-based lecture. Accompanying lines are next to each slide if students wish to add their own notes. 4

Slide 1 Disaster Health and Sheltering Part I: Independent Study National Student Nurse Program Narration by: Janice Springer, Red Cross Disaster Health Services Advisor Cheryl Schmidt, Red Cross Nursing Education Subject Matter Expert Slide 2 2 Slide 3 Red Cross Principles Humanity Impartiality Neutrality Independence Voluntary service Unity Universality 5

Slide 4 Red Cross Nursing: Our Legacy and Future Slide 5 Mississippi Flood Response, Courtesy of American Red Cross, May 2011 Slide 6 Red Cross Shelters 6 6

Slide 7 Joplin Missouri Tornado Response, Courtesy of American Red Cross, May 2011 Slide 8 PANDEMIC RESPONSE 8 Slide 9 Course Purpose To familiarize student nurses with Red Cross Disaster Health Services through Disaster Health and Sheltering, promoting volunteerism and community preparedness and post disaster resiliency. 9 7

Slide 10 Representing the Red Cross To each individual with whom you come in contact, you are the Red Cross! 10 Slide 11 Personal Preparedness You might be better prepared to help in your community if you have your own preparedness plan. STOP and take a minute to review some of the must haves in personal preparedness, both for your family and in your workplace. Slide 12 What s In YOUR Go Bag? 1. 2. 3. 4. 5. 8

Slide 13 Role of Disaster Health Services v Provides health assessments, treatment, and referrals as needed to people affected by disasters. v Coordinates with local public health authorities and local medical, nursing and other health resources. 13 Slide 14 In Certain Instances: Disaster Health Services may supplement existing service delivery systems for community health care. 14 Slide 15 Disaster Health Services Competencies v Critical thinking v Assessment v Technical skills v Illness and disease management v Information and healthcare technologies v Ethical behavior v Character based on values v Confidentiality 15 9

Slide 16 Client Commitments for Disaster Health Services v Respect confidentiality v Accommodate diverse needs v Follow Disaster Health Services Guidance v Make effective referrals v Identify and prevent potential health problems v Maintain ethics v Document accurately and appropriately v Work as a team v Involve community partners v Use resources wisely 16 Slide 17 Individual Injury and Illness: Sudden Onset HS Workers Assess and Treat/Refer Clients most often for: v Bone, muscle, and joint injuries v Respiratory distress v Lacerations and puncture wounds v Exposure to extreme weather conditions v Rashes v Burns 17 Slide 18 What HS Workers Assess and Treat/Refer (cont.) Stress-related Symptoms v Fluctuation in normal vital signs v Gastrointestinal upset v Headache v Labor can begin earlier than expected v Irritability v Exhaustion v Presenting symptoms may vary v Malaise v Pain 18 10

Slide 19 Mini-Case #1 What will you be considering for care of this client and her family? 19 Slide 20 Mini-Case Study #2 One shelter couple has slept pretty much continuously for 3 days. You are concerned as the shelter nurse, as is the Disaster Mental Health worker. As the couple gets up on the 4 th day, both of them have respiratory viral infections. Both Disaster Health Services and Mental Health reach out to them and help them move to a better sleep/exercise schedule. What are your concerns related to this ongoing for 3 days? 20 Slide 21 Mini Case answers Concerns include: depression overwhelmed exhausted at risk for pneumonia blood clots dehydration 21 11

Slide 22 More disaster-related client needs Aggravation of Chronic Health Conditions v Hypertension v Cardiac problems v Respiratory problems (e.g., asthma) v Gastrointestinal problems v Diabetes v Allergies v Mental health changes 22 Slide 23 What HS Workers Do... v Screen and assess clients to meet access/functional needs. v Care for disaster-related or -aggravated injuries or illnesses. v Assist to provide durable medical equipment, consumable medical supplies, personal care assistance for health maintenance. v Provide casework for disaster related health needs, to include fiscal assistance for health and/or medical needs. v Replace immediate-need prescriptions. v Replace essential eyeglasses, prosthetic devices, hearing aids and other equipment lost as a result of the disaster. v Provide referrals to community health agencies. 23 Slide 24 What HS Workers Do (cont.) v Determine whether the condition or loss of DME is disasterrelated and to what extent client resources are available for immediate needs. v Use other available resources first before Red Cross donated dollars are spent. 24 12

Slide 25 Client Interview Sample Questions for Replacement Assessment: v What happened to the glasses, medication, equipment? v Is the loss or need disaster-related? v Does the client need help with replacement? v Is third-party coverage available? v Who is the health care provider who ordinarily cares for the client? (Is there a prescription?) 25 Slide 26 Who are Red Cross Clients? All members of the affected community, which include: Non-English speaking Persons with Disabilities Clients who come with or without care-givers Affluent communities Culturally diverse communities **Disaster Health Services may also care for Red Cross workers when Staff Wellness volunteers are not available 26 Slide 27 Where HS Workers Are v Integrated Care Teams (for condolence or in-patient visits) v Emergency Aid Stations v Outreach v Community Settings (e.g., bulk distribution sites, Service Centers) v Home Visits 27 13

Slide 28 Other HS assignment settings (cont d) v Emergency Operations Center (EOC) Liaison v Aviation and Transportation Disaster support v Repatriation Team 28 Slide 29 HALFWAY THERE! Slide 30 Sheltering v Short term housing with sites determined by a predisaster shelter survey tool v Sites frequently in churches, schools v Shelter becomes a disaster community where individuals/families/groups receive mass care services (e.g., eating, sleeping shelter) as well as disaster health and mental health services v Accommodation made to meet needs of persons with disabilities and/or access and functional needs v Partnerships between the local Health Department and Disaster Health Services is key 30 14

Slide 31 Add another photo here 31 Slide 32 Possible answers: (These are a few of many possible.) A tent only provides minimal protection from the environment (think temperature, incoming storms, etc.). Rain/mud may impact mobility- restricted clients from access to restroom facilities. Tents can be confining. Often have no floors in the tent. Accessibility is a concern for individuals with functional limitations. 33 Slide 33 Shelter Considerations for Disaster Health Services v Registration: Assessment for vulnerabilities or need for extra health or mental health support v Dormitory set-up and its impact on families, persons who will need extra care, bathroom proximity v Communicable disease management v What other things come to mind??? 33 15

Slide 34 Identifying client needs Begins at Registration Staff makes two observations and asks two questions Observations for 1. Ability to proceed with registration-medically or behaviorally incapable of proceeding 2. Support needs-do they use a wheel chair, have a service animal or need hearing support. Slide 35 Two questions: Is there anything you or a member of your family needs right now to stay healthy while in the shelter? Yes / No If NO, is there anything you will need in the next 6-8 hours? Yes / No Do you/family member have a health, mental health, disability, or other condition about which you are concerned? Yes / No Slide 36 Process Steps Cot-to-Cot methodology CMIST as a framework for assessment Includes principles of surveillance 16

Slide 37 CMIST CMIST is an acronym that describes a system to help identify access and functional needs of clients in shelters. C = Communication M = Maintaining Health I = Independence S = Services, Support and Self-Determination T = Transportation Slide 38 Communication Need: Action: Slide 39 Maintaining Health Need Action 17

Slide 40 INDEPENDENCE Need Action Services, Support and Self-Determination Need : Action: Slide 41 Transportation Need: Action: Slide 42 18

Slide 43 Follow through Actions:! No needs identified! Contact Shelter Manager! Contact Disaster Mental Health Services! Agency, please provide agency name!other Follow-up/Resolution/date Disaster Health Services print name/signature/ date Slide 44 Cot to Cot Proceed with a systematic plan to meet each family within a reasonable time frame. The ideal time frame is 6-8 hours, however, due to immediate needs, it may take a full 24 hours to begin to know your shelter community. In a shelter of large population, consider assigning neighborhoods or sections for client support. Illness and injury reports use a Client Health Record. Functional support, such as communication, can be documented on the CMIST job form which is kept by Disaster Health Services. Slide 45 19

Slide 46 Slide 47 Case study A shelter has been opened in a community that has just experienced a flood. Over 80% of the homes and businesses in the downtown area have been affected. You are currently assigned to work at the registration desk of the shelter to assist in interviewing and registering community members as they enter the building. Mr. Jones, a single male who lives independently in the community, enters the shelter. He uses a wheelchair for mobility and has great difficulty hearing. In interviewing Mr. Jones, you learn that he has to catheterize himself to empty his bladder and requires dialysis twice a week at a local facility unaffected by the flood. 35 20

Slide 48 Mr. Jones v What are your immediate concerns as a nurse? v What are his risk factors? v What are his equipment needs? v Will he have transportation needs? v Can he be safely accommodated in this shelter? 36 Slide 37 CMIST model and Mr. Jones Communication---he is hard of hearing Medical health needs include catheterization Behavioral Health does he have risk factors?? Independence-what is he going to need to remain independent? Perhaps a care-giver? Mobility will he need help inside the shelter with w/ c? Supervision will he be able to self-cath in this setting? Transportation how will he get to dialysis? Slide 38 Behavioral health situations that might require higher level of care Clients with serious symptoms, e.g., acute anxiety or severe depression symptoms, clients who are disruptive to other residents Client disclosure of psychiatric condition or past experience that would make staying in the shelter unsustainable Clients experiencing significant distress due to the shelter environment, even after accommodations have been made (e.g., increased staffing, medications management) Active use of illegal drugs or alcohol in the shelter, which is against Red Cross sheltering policy 38 21

Slide 39 Prioritizing and Triage In a shelter that opens immediately after a disaster, you may need to prioritize clients and determine who needs care first, and who may need referral to either the emergency room or to a medical clinic. In a shelter that opens pre-landfall, you may have different levels of urgency but may still need to prioritize needs. Link here to learn more about principles of triage. http://en.wikipedia.org/wiki/triage 39 Slide 40 Integrated Community Health Response: PARTNERSHIPS v Red Cross Disaster Health Services v Local Public Health Department v Local clinics and agencies v Agency on Aging/AARP v Veterans Administration v Local hospitals v Advocacy groups v Schools/Universities v Hospice/Home Health agencies v Voluntary Organizations Active in Disaster (VOAD) 40 Slide 41 YOUR Community Partners 1. 2. 3. 41 22

Slide 42 Disaster HS Guidelines 42 Slide 43 Case Study You have been assigned to a shelter with a capacity to house 750 residents. A 13-year-old teenager, accompanied by her mother, arrives at the Health Services area complaining of itching, headache, poor appetite, and cold-like symptoms. Upon assessment, you find that her temperature is 102 o F and her back looks like this photo. Photo permission from DERMNZ, 2011) 43 Slide 44 Case Review v What communicable disease do you suspect? v Does anyone need to be notified? v What are the immediate actions that need to take place inside the shelter? v Possible alternatives to sheltering? 44 23

Slide 45 Documenting in Disaster Health Services Client Health Record Initial Intake Screening form Aggregate Morbidity (Surveillance) Client Assistance Memorandum--a referral form for internal partners Release of Confidential Information 45 Slide 46 HS Work is a Public Health Wheel FIT http://www.people.vcu.edu/~elmiles/interventions/ 46 Slide 47 Course Summary v Public Health Nursing involves assessment and care of individuals, families and communities. v HS response in Red Cross shelters is based in public health nursing. v Connect with your local Red Cross Chapter if you are interested in making a disaster response difference in your community. 47 24

Slide 48 Where can I go from here? Take classes (mixture of required and recommended): v Shelter Operations and Shelter Simulation v Mass Care v CPR (Professional) and First Aid (often free to volunteers) v Health Services Response Workshop core course for HS activity v Psychological First Aid v Client Casework: Providing Emergency Assistance 48 Slide 49 Questions about nursing in the American Red Cross? Find your State Nurse Liaison: http://www.redcross.org/www- files/documents/pdf/nursing/state_nurse_ Liaisons.pdf Find your local Chapter: Input your zip code in the top right-hand corner http://www.redcross.org/ 49 Slide 50 Red Cross Nursing: A future opportunity. 50 25

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