1. Medical Sheltering in Texas 2012 Texas Emergency Management Conference

2. Agenda 1. Medical Sheltering Basics 2. Texas Statewide Medical Shelter Plan 3. Medical Sheltering by Evacuation Area 4. Selecting the Appropriate Shelter 5. State Medical Shelter Support 6. Local & Regional Planning 7. Summary 2

3. MEDICAL SHELTER BASICS 3

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 4

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 5

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 6

7. TEXAS STATEWIDE MEDICAL SHELTER PLAN 7

8. State Support State supported medical sheltering is primarily focused on evacuees who are transported on state transportation resources through coastal evacuation hubs 8

9. 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.

10. 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.

11. MEDICAL SHELTERING BY EVACUATION AREA 11

12. Texas Medical Sheltering SE Texas Evacuation Area ◦ San Antonio5000 primary ◦ Tyler200 primary ◦ Tyler/Marshall400-600 additional 12

13. Texas Medical Sheltering Houston/Galveston Evacuation Area ◦ San Antonio5000 primary ◦ Austin250 additional ◦ Bryan/College Station450 additional 13

14. Medical Sheltering Matagorda & Corpus Evac Areas ◦ San Antonio5000 primary ◦ Austin250 additional ◦ Bryan/College Station450 additional 14

15. Medical Sheltering Lower Rio Grande Valley Evac Area ◦ Laredo450 primary ◦ San Antonio5000 primary ◦ Austin250 additional ◦ Bryan/College Station450 additional LRGV Shelter Plan (Cat 1 or 2) ◦ 2 medical shelters 15

16. SELECTING THE APPROPRIATE SHELTER 16

17. 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.

18. 18 The Shelter Options

19. 19 General Population Shelters Access to medical services Access to prescription medications Access to medical equipment May or may not be provided on site

20. 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

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 21

22. 22 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

23. 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

24. 24 Medical Population Shelter Placement Individuals who require active monitoring, management, or intervention by a medical professional to manage their medical condition

25. 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

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 26

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 27

28. 28

29. STATE MEDICAL SHELTER SUPPORT 29

30. 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

31. Shelter Infection Control Kit N95 Respirators Surgical Masks Non-latex Gloves Hand Sanitizer Disinfectant Wipes Tissues Alcohol Wipes Exam Gowns

32. Contracts BCFS Pharmacy Medical Staffing ◦ Medical Doctors ◦ Physicians Extenders (NP, PA, etc) ◦ Nurses ◦ EMTs/Paramedics ◦ Other Medical Specialties

33. LOCAL & REGIONAL PLANNING 33

34. Planning Considerations State Plan ◦ Major events  Hurricane evacuation  Large scale disasters Local Plan ◦ Smaller local events  Ice storms  Power outages

35. Planning Considerations Local plans are still necessary Planning is essential ◦ Know your jurisdictional demographics ◦ Know your resources ◦ Know your partners

36. Jurisdictional Demographics What percentage of your population may need a medical shelter during an event? What percentage of your population may not need a medical shelter, but may have functional or access needs? What are the age demographics of your population? The more knowledgeable you are about your population, the better your planning will be.

37. Resources Sites Transportation Medical assets Food Wrap around services Assistive services Staffing

38. Partners No you can’t do it alone ◦ Medical Reserve Corp ◦ Citizen Emergency Response Teams ◦ Hospitals ◦ Home Health ◦ Public Health ◦ Emergency Management ◦ Regional Advisory Councils ◦ Department of Public Safety ◦ Volunteer and Advocacy groups ◦ Local businesses ◦ Elected officials ◦ Others…

39. SUMMARY 39

40. Summary 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 40

41. Summary Chronic and minor medical conditions in general shelters FNSS support in gen pop shelters Access to medical services in gen pop shelters Know your population – demographics Identify resources now Identify and plan with local partners now 41

42. QUESTIONS? 42 Debbie Evans Texas Department of State Health Services deborah.evans@dshs.state.tx.us Jeff Hoogheem Texas Department of State Health Services jeff.hoogheem@dshs.state.tx.us