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Table of ContentsHow to Use this Curriculum.........................................................................................................................3

Objectives of the Training............................................................................................................................3

Training Guidelines......................................................................................................................................3

Training Agenda (Template)........................................................................................................................5

Lesson Plan..................................................................................................................................................6

Patient Scenarios.......................................................................................................................................10

Pre/Post Test.............................................................................................................................................14

Pre/Post Test Answers...............................................................................................................................16

Evaluation..................................................................................................................................................17Shelter Surveillance Work GroupParticipating Organizations: American Red Cross, City of Nashua, NH Division of Public Health and Community Services, Manchester Health Department, New Hampshire Department of Health and Human Services2014

Conducting Health Surveillance in

Emergency Shelters

Training for Medical VolunteersGuidance Document

The guidance also includes a section on how to modify this curriculum for non-medical volunteers and trainings with American Red Cross volunteers.

How to Use this CurriculumThis training has been developed by the Shelter Surveillance Work Group to train medical volunteers, such as the Medical Reserve Corps, to conduct health surveillance in emergency shelters during disasters and large scale emergencies. This training follows the guidance from the New Hampshire Department of Health and Human Services (NH DHHS) on how to conduct shelter surveillance in shelters and assists in fulfilling Capability 7, Mass Care, Function 4, “monitor mass care population health”, Task 2, “during an incident, conduct surveillance at congregate locations to identify cases of illness, injury and exposure within mass care populations”.

Objectives of the Training Describe how shelter surveillance has been used in national disasters, such as the

response to Hurricane Sandy. Understand how health surveillance can be conducted in an emergency shelter to increase

situational awareness of disease and illness during disasters. Gain a basic understanding of protocol and process for conducting health surveillance in

New Hampshire emergency shelters. Gain knowledge in preventing and managing disease outbreak in shelters. Understand how facility-specific environmental health and safety assessments are

performed at emergency shelters during disasters. Describe how to use Natural Disaster Morbidity Survalance Individual Form (aka

“Individual Form) to doccument individual health visits in shelter. Describe how to use Natural Disaster Morbidity SurveillanceSummary Report (aka

“Summary Report”) to summarize health visits in shelter.

Training GuidelinesThe members of the Shelter Surveillance Work Group can present this training to medical volunteers. It is best that 2 presenters are present to lead the training but it can be done with one person.

Handouts for Participants:

Copy of the PowerPoint Copy of the 3 shelter surveillance forms

o Natural Disaster Morbidity Surveillance “Individual Form”o Natural Disaster Morbidity Surveillance “Summary Report”o Environmental Health Assessment Form

Evaluation Form Pre and Post Test

1

Other Documents:

1 copy of the NH DHHS Guidance document for the class, not each person 1 copy of the American Red Cross shelter surveillance form for the class, not each person Sign-In Sheet

Equipment needs:

Projector and laptop Blank wall or projector screen Memory stick with the PowerPoint Pens Extension cord

Altering this Training for Use with Non-Medical VolunteersTBC

Incorporating Shelter Surveillance into American Red Cross TrainingsTBC

2

Training Agenda (Template)

Conducting Health Surveillance in Emergency Shelters

Agenda

[insert date, time]

[insert location]

I. Welcome and Introductions

II. Pre-Test

III. Overview of Surveillance in Shelters

a. Utilization of health surveillance in national disasters

b. Goals of health surveillance in emergency shelters

c. NH DHHS Guidance Document

d. Preventing and Managing disease outbreaks in a shelter

IV. Case Studies and Form Review

a. Natural Disaster Morbidity Surveillance “Individual Form”

b. Natural Disaster Morbidity Surveillance “Summary Report”

c. Environmental Health Assessment Form

V. Post-Test

VI. Evaluations

Training Developed by the Shelter Surveillance Work GroupParticipating Organizations: American Red Cross, City of Nashua, NH Division of Public Health and Community Services, Seacoast Public Health Network, Manchester Health Department, New Hampshire Department of Health and Human Services

3

Lesson PlanObjectives Content Teaching

MethodTime Time

TakenAssessment

Pre-Test Pre-Test Self Evaluation of Knowledge of Material

10 minutes

< 5 Minutes

Overview PowerPoint (Slides 1-4)

Lecture, Discussion

< 5 minutes

4 Minutes

Describe how shelter surveillance has been used in national disasters, such as the response to Hurricane Sandy.

PowerPoint (Slides 5-7)

Lecture, Discussion

5 minutes

6 Minutes In shelters open after Hurricane Katrina and Hurricane Sandy, health surveillance was used to identify acute illness symptoms and management of chronic illness, and injury in residents. True/False

Understand how health surveillance can be conducted in an emergency shelter to increase situational awareness of disease and illness during disasters.Gain a basic understanding of protocol and process for conducting health surveillance in New Hampshire emergency shelters.Gain knowledge in preventing and managing

PowerPoint (Slides 8-17)

Lecture, Discussion

10 minutes

22 Minutes

The goals of conducting health surveillance in emergency shelters include (circle all that apply):

Prevent outbreaks or implement infection control measures at the onset of an outbreak

Prevent the spread of communicable diseases

Implement measures to prevent injuries

5

Objectives Content Teaching Method

Time Time Taken

Assessment

disease outbreak in shelters.

Prevention measures to decrease the spread of illness include all of the following except:triage, hand hygiene, use of personal protective equipment, calling 911, reporting signs and symptoms associated with communicable disease, isolation and quarantine

Understand how facility-specific environmental health and safety assessments are performed at emergency shelters during disasters.

PowerPoint (Slides 18-20) Review the types of domains assessed using this tool (Facility, Food, etc.)

Lecture, Discussion, Handout “Environmental Health Assessment Form”

5 Minutes

8 Minutes When should the “Environmental Health Assessment Form” be completed during shelter operations?

24 hours prior to opening a shelter, and then every 12 hours during shelter operations

Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours and as needed during shelter operations

As needed

6


Time Time Taken

Assessment

after an environmental hazard has been identified

Describe how to use Natural Disaster Morbidity Survalance Individual Form (aka “Individual Form) to doccument individual health visits in shelter.

Describe how to use Natural Disaster Morbidity SurveillanceSummary Report (aka “Summary Report”) to summarize health visits in shelter.

PowerPoint (Slides 21-50),allowing participants to practice completing forms on their own

Lecture, Discussion, Handout “Individual Form” and Handout “Summary Report”, Case Studies, Practice

30 Minutes

32 Minutes

(Group participation will also assist with assessment of comfort level with form.)What is an example of a trigger for the shelter manager contact NH DPHS to discuss shelter surveillance:

When a patient has an oral temperature of 100.4 degrees F or greater

When a patient has been transported to a hospital for care

When three or more residents with similar symptoms report for care in a 24 hour period

Wrap Up Discussion / Questions

Group Discussion / Questions

5-10 Minutes

7


Time Time Taken

Assessment

From Participants

Post Test & Evaluations

10 Minutes

5 Minutes

Total Time: 60 – 85 Minutes

Approx. 82 Minutes

*Time Taken indicates the amount of time it took during a real-life training with a MRC unit.

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Patient Scenarios

9

Case # Clinical Presentation

Initial Follow Up

Clinical Follow Up

Clinical Documentation

Shelter Considerations

#1 A 29 yo female shows up at the registration desk with red, watery eyes and states that she has some muscle aches. She has 3 children, the youngest is a 9 mo who is breast feeding and has loose stools.

This person is referred from registration to the medical station.

At the medical station they are found to have a semi productive cough and a fever of 100.4 degrees F. She is given a mask to wear and encouraged to call her doctor. The 9 mo year old is afebrile and has no other symptoms. The mother is educated on hand hygiene and states she has enough diapering supplies for the night.

Under “Acute Illness/Symptoms” Fever and muscle pain and productive cough are checked off for the mother. ILI is checked off at the bottom of the page. A separate form is completed for the 9 month year old, and watery diarrhea is checked off. Disposition is discharge to self care for both mother and child.

The family is given their own room to stay in.

#2 A 12 yo comes in to the medical station with a diffuse rash and an oral temp of 99.9 deg F. Rash is itching and started 2 days prior to coming to the shelter.

This person is already at the medical station.

Questions to this patient include other symptoms present, allergies, immunization history, health of family members, and occupation. If differentials do not lead to diagnosis, then patient is encouraged to call physician.

Rash is checked. Disposition is either discharge to self care or refer to other care, physician.

This person is monitored by shelter medical staff, and they are encouraged to return to the medical station if symptoms change.

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Case # Clinical Presentation

Initial Follow Up

Clinical Follow Up



#3 The first lunch is being served since the shelter opened; it is hamburgers and salad. The hamburger is properly cooked, but the lettuce is packaged. About 48 hours after this lunch, 4 shelter residents start complaining of nausea, vomiting and diarrhea

These residents are directed to the medical station.

Noticing a pattern of similar symptoms, the workers at the medical station notify their Medical Unit Leader.

(We can tally this any way.)

Since more than 3 shelter residents with similar symptoms in a 24 hour period, the shelter manager calls NH DPHS at 603-271-4496 or (NH only) 1-800-852-3345 ext. 4496 (weekdays) or ext. 5300 (after hours), as it is indicated in the guidance (page3).

#4 A 68 year old male using portable oxygen arrives at the medical station complaining of a cough and runny nose. He has a productive cough and is short of breath, unable to complete whole sentences.

This person is already at the medical station.

The breathing issue is priority over the infectious disease symptoms. 911 is called. The client is encouraged to sit down and is monitored continuously by medical staff until EMS arrives.

Under respiratory section, congestion, runny nose, sinusitis is checked off with productive cough and shortness of breath/difficulty breathing. Disposition is admit/refer to hospital.

The shelter manager is made aware that 911 has been called. A shelter volunteer is sent to the parking lot to receive EMS and direct responders to the patient.

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Case #Clinical Presentation

Initial Follow Up

Clinical Follow Up



#5 A 32 yo food worker comes into the shelter c/o fatigue and joint pain. Staff notices that the sclerae are not clear white.

He is sent to the medical station.

He tells the nurse that the discoloration in his eyes is new, and he noticed his stools were “grayish” in color. He has been working at your shelter for a week feeding residents. He is encouraged to call his doctor.

Jaundice is checked under acute illness/symptoms. muscle or joint pain is checked. Disposition is refer to other care.

The shelter manager is made aware a food handler has hepatitis like symptoms.

#6 59 to diabetic with neuropathy c/o ear ache and sore throat.

This person is referred to the medical station.

This person is afebrile. He is encouraged to cough into his arm and frequently wash his hands. He is provided with education related to diabetes management and acute illness.

Cough and sore throat are checked. Disposition is discharge to self care.

This person only requires standard precautions, and does not require spatial distancing at the shelter.

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Pre/Post TestHealth Surveillance in Emergency Shelters

*Pre* / Post TestMRC

1. In shelters opening after Hurricane Katrina and Hurricane Sandy, health surveillance was used to identify acute illness symptoms and management of chronic illness, and injury in residents.

True False

2. The goals of conducting health surveillance in emergency shelters include (circle all that apply):

Prevent outbreaks or implement infection control measures at the onset of an outbreak Prevent the spread of communicable diseases Implement measures to prevent injuries

3. Prevention measures to decrease the spread of illness include all of the following except:

Triage Hand hygiene Use of personal protective equipment

Calling 911

Reporting signs and symptoms associated with communicable disease

Isolation Quarantine

4. When should the “Environmental Health Assessment Form” be completed during shelter operations?

24 hours prior to opening a shelter, and then every 12 hours during shelter operations Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours and as

needed during shelter operations As needed after an environmental hazard has been identified

5. What is an example of a trigger for the shelter manager contact NH DPHS to discuss shelter surveillance:

When a patient has an oral temperature of 100.4 degrees F or greater When a patient has been transported to a hospital for care When three or more residents with similar symptoms report for care in a 24 hour period

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Health Surveillance in Emergency Shelters

Pre / *Post* TestMRC

3. In shelters opening after Hurricane Katrina and Hurricane Sandy, health surveillance was used to identify acute illness symptoms and management of chronic illness, and injury in residents.

True False





Calling 911




24 hours prior to opening a shelter, and then every 12 hours during shelter operations Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours and as

needed during shelter operations As needed after an environmental hazard has been identified


When a patient has an oral temperature of 100.4 degrees F or greater When a patient has been transported to a hospital for care When three or more residents with similar symptoms report for care in a 24 hour period

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Pre/Post Test Answers

Health Surveillance in Emergency SheltersPre / Post Test ANSWERS

5. In shelters open after Hurricane Katrina and Hurricane Sandy, health surveillance was used to identify acute illness symptoms and management of chronic illness, and injury in residents.

True False





Calling 911




24 hours prior to opening a shelter, and then every 12 hours during shelter operations Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours

and as needed during shelter operations As needed after an environmental hazard has been identified


When a patient has an oral temperature of 100.4 degrees F or greater When a patient has been transported to a hospital for care When three or more residents with similar symptoms report for care in a 24 hour

period

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EvaluationConducting Health Surveillance in Emergency Shelters

Strongly Disagree Disagree Neutral Agree

Strongly Agree

The objectives of this training were achieved:Describe how shelter surveillance has been used in national disasters, such as the response to Hurricane Sandy.Understand how health surveillance can be conducted in an emergency shelter to increase situational awareness of disease and illness during disasters.Gain a basic understanding of protocol and process for conducting health surveillance in New Hampshire emergency shelters.Gain knowledge in preventing and managing disease outbreak in shelters.Understand how facility-specific environmental health and safety assessments are performed at emergency shelters during disasters.

Describe how to use the surveillance forms.

The timeframe for this training was appropriate.The presenters were knowledgeable, organized and effective in their presentation.The teaching strategies/resources were effective.The following were satisfactory: food, facilities, and parking.

What did you like best about this session?

What would you do to improve this session?

Additional Comments/Suggestions:

Thank you for attending today’s training. We welcome your feedback on how to improve by taking a few minutes to fill out this evaluation form.

THANK YOU!

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