CDR Harvey Ball, ASPR-ABC LCDR Joe Holshoe, ACF

What is the FNSS?  Guidance created by FEMA in coordination with Department of Justice  Planning for the integration of functional needs support services (FNSS)into general population shelters  Based upon the application of the Americans with Disabilities ACT (ADA)– which is NOT waived during a disaster  Communities and States must plan for the integration of functional needs populations in their general population shelters  Medical shelters only for those requiring intensive medical care

What are Functional Needs Services  Services that enable individuals to maintain their independence in a general population shelter, i.e.,  Reasonable modification to policies, practices, and procedures  Durable medical equipment (DME)  Consumable medical supplies (CMS)  Personal assistance services (PAS)  Other good and services as needed  Others who may benefit: women in late stages of pregnancy, elders, and those needing bariatric equipment

Functional Needs Examples  Dietary  Special diets  Communication  Language & other communication services,.i.e., visual  Mental health services  Quiet areas  Medications  Access to meds to maintain health & mental functioning  Durable medical equipment  Oxygen  Transportation  Para-transit  Sleeping accommodations  Accessible cots, child & bariatric cots

How is this accomplished?  States and communities are expected to establish MOU’s with local area pharmacies, clinics and hospitals, durable medical equipment suppliers, catering companies, and transport services to provide these services when called upon  Shelters are expected to plan for and provide the staffing required for these services via training and MOU’s

The FNSS Process 1. Individual arrives at shelter 2. Initial screened for needs 3. If needs identified, medical screening for nature of care required (NOT diagnosis driven, but care required driven) 4. Provide appropriate functional supports within the capabilities of the shelter

Medical Care in the General Population Shelter Medical Providers  Physicians, Registered Nurses, Licensed Vocational Nurse, EMT’s and Paramedics  Psychiatrists and Dental providers  Emergency veterinary service provider  Access to dialysis treatments (this includes providing access to transportation to and from the dialysis facility and a meal(s) if a resident is not at the shelter during meal time(s)) DME providers  Oxygen providers Medical Staffing Services  On-site nursing services  Emergency medical services  Emergency dental services  Pharmaceutical services Resource Suppliers  O2  Dialysis  Constant power source  Blood sugar monitoring

General Population Medical Staff Recommendations  Onsite Medical Staff Provide OTCs Implement methods to minimize contagion Make referrals for emergency medical and dental treatment  Medical Station  Staff with a minimum of 1 RN and 1 paramedic at ratio of 1:100 shelter residents at all times  On-Call Medical Staff  Maintain on call physician and psychiatrist 24/7

Shelter populations  Shelter populations most often a component of under-served populations  Multiple needs, i.e., chronic medical, behavioral health needs, limited resources, few social supports  Those that can afford to stay at a hotel, stay at a hotel!  Pets to people shelter ratio  Historically, FMS provided care for chronic conditions rather than acute injury

FNSS: Potential Challenges  Training & credentialing of appropriate staff  Team work required for effective medical evaluation and care  Security of medicines and medical supplies  Legal liabilities to those who provide Rx & medical supplies  Monitoring: patients can go down hill fast  OHSA compliance for DME & medical waste  Potential for admitting all persons for fear of legal action  Potential to eliminate small shelters who cannot contract for FNSS support services  Confusion over the nature & implications of FNSS  Possible short notice ESF-8 request s

FNSS: State-Specific Challenges  Must have plans and MOU’s for multiple support services  Requires trained medical screeners  Requires trained & credentialed nursing/care- giving staff  Requires documentation and management of various support services, i.e., Rx & DME  If no Presidential Declaration– significant financial burden

FEMA is the overall lead for the federal emergency response ASPR is the USG lead for Emergency Support Function ESF-8, Public Health and Medical ACF is the HHS lead for ESF 6 (Mass Care, Sheltering & Human Services) in support of FEMA OFRD—through the RDFs—is one of the main staffers of the Federal Medical Station

So What has been the Response to the FNSS?

Medical Providers Response: “PEOPLE WILL DIE!”

Shelter’s Response: WE DON’T HAVE THE PEOPLE OR SUPPLIES!

FMS Mission Statement An FMS is designed to accommodate 250 patients with conditions requiring observation, assessment, or maintenance; chronic conditions which require daily living assistance, assistance with medication administration, and home nursing care that does not require inpatient hospitalization. An FMS is not an acute care hospital, inpatient hospital ward, or emergency department, but rather a primary care platform with temporary holding capacity. The scope of care for this configuration includes medical, nursing, mental health, and therapy care for non- complicated and stable non-acute patients; to include medical workups and examinations required during recovery, nursing care for special needs patients (to include geriatric, limited bariatric, and limited pediatric and obstetric), administration of medical and nursing treatments, and administration of vaccines or other countermeasures.

Medical Care in the General Population Shelter Medical Providers  Physicians, Registered Nurses, Licensed Vocational Nurse, EMT’s and Paramedics  Psychiatrists and Dental providers  Emergency veterinary service provider  Access to dialysis treatments (this includes providing access to transportation to and from the dialysis facility and a meal(s) if a resident is not at the shelter during meal time(s)) DME providers  Oxygen providers Medical Staffing Services  On-site nursing services  Emergency medical services  Emergency dental services  Pharmaceutical services Resource Suppliers  O2  Dialysis  Constant power source  Blood sugar monitoring

So what is the role of the FMS in the FNSS?

How Does PHS Fit?

 Historically PHS provided/assisted with:  FMS  Service Access Teams  Shelter Assessment Teams  Technical Assistance and Subject Matter Experts  MRC

PHS can help meet FNSS needs:  Large population of deployable nurses  Deployable providers  Deployable pharmacists  SAT  SME/TA  Shelter Assessment Teams  Liaison for national advocacy organizations

FNSS: Potential for PHS  Focus on core mission of PHS  PHS exposure to general population  Reinforce the value that PHS provides  Serve underserved, at-risk & vulnerable populations

Partnering with the community  Community advocates know their communities needs and strengths  Knowledge asset  Functional need specific groups  All Disasters are local events  Build from the ground up  Many advocacy groups have EPR programs that can serve as foundation for shelter planning

Community Partners  Shelters will have to leverage the skills of community organizations  AIDS Projects  Visiting Nurses Associations  Hospices  Community Advocacy Groups  State nursing boards  ECAR-VHP coordinators  CERT Teams  A new role? Less emergency response, more basic care skills