The Public Health Challenge in Mass Evacuation and Shelter Care
“Medical shelters have unique requirements for information related to patient medical history, unique supply, and intense communication with community assets in planning the return of individuals to their home setting.”
Part 3 of 5
Written by RADM Craig Vanderwagen, M.D., USPHS (Retired)
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This essay will examine the specifics of preparing for a mass evacuation, conducting such an evacuation with a focus on the medical and public health needs of the affected population and the information needs in shelter environments. This discussion will be limited to domestic events although many of the same approaches have merit in an international response.
The information base described here will begin to look not only at the tactical concerns, but will discuss those data elements important in guiding operational management of the tactical assets, and allow for assessment of progress towards meeting the strategic goals of saving lives, reducing the burden of health problems, and speeding recovery. This essay will begin to elucidate those elements that are critical for effective situational awareness.
Public Health's Mass Evacuation Challenge - Video Transcript
The logistics of evacuation and shelter management are critically important to those of us in the public health community. I think that's because we're aware that the most vulnerable populations are those who get adversely affected in poor evacuation outcomes and those of the people who need an effective and capable medical sheltering process more than anyone else. Evacuation could occur in an orderly fashion or it can be chaotic. We experienced Katrina, a very chaotic event but we've learned from that. And one of the things we learned was that populations with special needs need to be identified well ahead of an event, their location identified, a unique means of conveyance for their evacuation and a destination for evacuation become critically important. Managing all this information requires a technological solution that allows for a clear understanding of those who are at risk and how they'll be moved.
As an example, for instance, in 2006 one of the things that we did that was much better than Katrina we went to every nursing home, 110 of them below I-10 between the Texas border and the Mississippi border in the state of Louisiana and identified 3,000 plus individuals. Each one of those individuals had a destination identified for their evacuation and a unique means of that evacuation occurring. Managing all that information is critically important to assure the quality and to assure that the progress of that evacuation goes as planned.
Shelter management is also a challenge. Certainly, there are challenges associated with patient registration and patient information but first order of business is do we have the right personnel to staff these with the right credentials and can we get them there in a timely fashion.
Understanding who those people are and how we will move them and whether they have the right credentials, again, presents us with an information management challenge. We have learned how to manage that information much more effectively in a post Katrina environment. Lastly, having those people there with the right skills in the right time will be a failure if we cannot provide them with appropriate supplies and it becomes critical because we can generally put three days’ worth of supplies there. But if we go beyond those three days, we have to be able to resupply them and do it before it reaches crisis stage.
So again, understanding the supply status in these shelters is critically important and having an information system that allows us to understand where the shortages may occur and to push assets into that environment before we reach crisis that's the end game that we're looking for. We've come to achieving it. It will take continued work to assure that we have a comprehensive system that assures an orderly and efficient evacuation of the most vulnerable populations and a sheltering environment that takes their medical needs and cares for them in the best possible way.