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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 1
Medical Sheltering
Jeffrey Hoogheem – DSHS
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
Agenda
1. Medical Sheltering Basics2. Texas Statewide Medical Shelter Plan3. Medical Sheltering by Evacuation Area4. Selecting the Appropriate Shelter5. Medical Shelter Resources6. Summary
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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
MEDICAL SHELTER BASICS
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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 4
Medical Shelter Plan Basics
• Medical Shelters are primarily for high acuity evacuees (and caregivers) requiring skilled nursing care and constant medical oversight
• Identification of medical evacuee is critical at embarkation hub– Reduce time on road– Medical evacuees arrive at the correct destination– Reduces evacuee being moved twice
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 5
Medical Shelter Plan
• Establish medical shelters in San Antonio and other selected cities, as required– Evacuate medical evacuees to San Antonio
first– Evacuate medical evacuees to other selected
cities, as necessary– Establish/support medical shelters in other
locations as necessary
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 6
Medical Support Considerations
• Local medical professionals• Access to physician office or clinic• Medical emergency- call 911• On-site clinical care• Request DSHS Mobile Medical Team – 8 teams currently rostered
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
TEXAS STATEWIDE MEDICAL SHELTER PLAN
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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 8
State Support
• State supported medical sheltering is primarily focused on evacuees who are transported on state transportation resources through coastal evacuation hubs
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 9
Medical Evacuation• In the past (prior to
2010) medical evacuees were evacuated to multiple locations across the state of Texas.
• We now plan to consolidate Medical Sheltering in San Antonio.
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 10
Medical Shelter Plan• Advantages of consolidating medical sheltering in
San Antonio– Consistent levels of care– Consolidation of resources– Access to significant medical system in a major city– Ability to allocate resources properly to best
support the population including:• transportation assets, hospital beds,
pharmaceutical caches, medical equipment caches etc.
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
MEDICAL SHELTERING BY EVACUATION AREA
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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 12
Medical ShelteringProposed Plan
SE Texas Evacuation Area– San Antonio 5000 primary– Tyler 200 primary– Tyler/Marshall 400-600 additional
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 13
Medical ShelteringProposed Plan
Houston/Galveston Evacuation Area– San Antonio 5000 primary– Austin 250 additional– Bryan/College Station 450 additional
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 14
Medical ShelteringProposed Plan
Matagorda and Corpus Evacuation Areas– San Antonio 5000 primary– Austin 250 additional– Bryan/College Station 450 additional
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 15
Medical ShelteringProposed Plan
Lower Rio Grande Valley Evacuation Area– Laredo 450 primary– San Antonio 5000 primary– Austin 250 additional– Bryan/College Station 450 additional
LRGV Shelter Plan (Cat 1 or 2)– 2 medical shelters
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
SELECTING THE APPROPRIATE SHELTER
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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 17
Population Definitions• General evacuees:
Ability to function independently each day. Evacuee may or may not have disabilities, functional or access needs including minor medical care
• Medical evacuees:Require skilled medical care and are people that may or may not have disabilities, functional or access needs.
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 18
The Shelter Options
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 19
General Population Shelters
• Access to medical services
• Access to prescription medications
• Access to medical equipment
• May or may not be provided on site
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 20
Medical Shelters
• Medical staff on site• Medical equipment and
services on site• Access to prescription
medications, may or may not be provided on site
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 21
Medical Support to Shelters
Jurisdictions that provide sheltering (pt to pt, hub cities, drive-ups) should have capacity to provide medical services– Medical services to general population
shelters– Establishment of a medical shelter
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General Population Shelter Placement
• Individuals who are able to meet their daily needs either by themselves or with a caregiver and may require some assistance with activities of daily living
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 23
General Population Shelter Placement
• Some examples include people that are: – Dependent on medical oxygen– Mobility disability /self ambulating with or without
DME, including wheelchair– Deaf or hard of hearing, blind or low vision with or
without a service animal– Diabetic, insulin dependent/diet controlled– People with no disabilities, functional or access needs
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 24
Medical Population Shelter Placement
• Individuals who require active monitoring, management, or intervention by a medical professional to manage their medical condition
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 25
Medical Population Shelter Placement
• Some examples include people who are:– Hospice patients– Ventilator patients– Tracheotomy which requires suctioning– Extensive wound management requiring a sterile environment
or suctioning– Requiring isolation due to infectious disease– Dysrhythmia management– Receive skilled nursing care at home– Previously from a skilled nursing facility but have no access to a
skilled nursing home/facility
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 26
Shelter Selection Process
• Triage personnel should do a rapid assessment to determine the most appropriate shelter placement option for evacuees– Individuals requiring skilled medical care will go to
medical shelters– Some evacuees with lower acuity medical needs can
go to general population shelters but may have a choice of a medical shelter
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 27
Shelter Selection Process
• Triage personnel should provide information to the individual about the type of shelters and services available in each
• If the individual does not require skilled medical care but still meets medical shelter placement criteria then the individual will make an informed decision regarding his or her own placement
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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
MEDICAL SHELTER STAFF & RESOURCES
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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
Medical Shelter Push Pack• Support 100 Patients• 3 Pallets• Includes items such as:– General Medical Supplies– Sharps Containers– O2 Masks & Regulators– Pillows/Blankets/Towels– Diapers– Flashlights– OTC Medications
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
Shelter Infection Control Kit
• N95 Respirators• Surgical Masks• Non-latex Gloves• Hand Sanitizer• Disinfectant Wipes• Tissues• Alcohol Wipes• Exam Gowns
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
Contracts
• BCFS• Pharmacy • Medical Staffing– Medical Doctors– Physicians Extenders (NP, PA, etc)– Nurses– EMTs/Paramedics– Other Medical Specialties
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
SUMMARY
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TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 34
Transitional Planning
• No longer using categories 0-5• Two types of evacuees– Medical evacuee– General evacuee
• For Transition Planning:– 0-3 probable gen pop shelter– 4 medical shelter– 5 institutional facility
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT 35
2012 Transitional Planning
• Jurisdictions with pt to pt and Hub areas– Primarily focused on general evacuees– Chronic and minor medical conditions in
general shelters– FNSS support in gen pop shelters– Access to medical services in gen pop shelters
TEXAS DEPARTMENT OF STATE HEALTH SERVICESTEXAS DIVISION OF EMERGENCY MANAGEMENT
QUESTIONS?
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