Should Hospitals Serve as Shelters in Emergencies?

[firedude 985]

Snowstorm fallout: Should hospitals serve as shelters in emergencies?

Amanda Cuda, Staff Writer

Published 06:15 p.m., Sunday, November 13, 2011

During the late October snowstorm that left more than 800,000 homes without power throughout the state, Seymour EMS Director Scott Andrews noticed there was a group of people needing a highly specialized type of care. They were on ventilators, required refrigerated medication or simply were frail elderly who couldn't survive without heat. "These were people who don't need the type of care that a hospital provides, but they do need to have assistance available beyond what we could offer at our shelter," Andrews said.

Full Greenwich Times Article

Any thoughts?

Edited November 14, 2011 by firedude

[ny10570 745]

I'm really surprised these hospitals didn't have plans for this. Every hospital has a different variation, but in NYC in the event of blackout patients that can no longer stay home but not in need of the hospital are kept in the er. If the incident is too large or persists for to long to be handled in the ER these patients are transferred to nursing facilities.

The plans have been used for neighborhood blackouts, and work well. A few years ago when the north Bronx lost power the ERs were filed with beds and staff awaiting the flood of patients. The incident generated maybe a dozen of these types of patients and didn't come close to overwhelming the ER. As I wasn't in NYC during the last widespread blackout I cannot speak to how well everything went then.

[Guest alsfirefighter]

I think its a thought but I'm wondering how some of our local hospitals who are often packed beyond capacity as it is in the ER and have no or little available space on the floors would be able to deal with such a thing. It does bring back to mind some things I always wanted to get a better understanding of and work on some training topics about which is the amount of people we are seeing at home which 15-20 years ago was unheard of. This goes for long term care type scenarios with devices to those who now go home hours after significant surgery.

[NJMedic 96]

I am a emergency manager at a large hospital in NJ.

Using hospitals as a shelter is full of issues. The historical reference would be hospitals in New Orleans during Katrina. The general public was taken in because the thought was the storm would be over in <12 hours. The all changed when the levees broken and the City was flooded. Many hospital lost power and HVAC and all the other comforts that people take for granted. Combine this with the fact these evacuees simply could not go anywhere else lead to some very "interesting" times. Unable to find food the "guests" decided to raid the pantry of the hospitals and enter other unauthorized areas. It and of itself this would have been only a major problem but the hospital still had to provide medical care, food and other services to the patients who were not evacuated as well as the staff taking care of them. Part of the Joint Commission elements of performance is that hospitals provide a means to shelter employees,their families, and possible their pets. This in light that a hospital needs staff to run it. The staff will be more inclined to support the hospital if the hospital can provide for their families. As witnessed in Katrina many people would not evacuate because provision had not been made for pets. This process is very complicated. There are 4500 employees at my hospital. If if have had two kids per family that is still 4500 kids I'm expected to shelter.

A Special Needs Shelter is an emergency facility capable of providing special medical or nursing care which does not necessitate an acute care hospital setting. Despite that fact some patient do end up at a hospital. That is very expensive. We did take in 24 patients from a nursing home that was flood but we were able to put them in their own unit because we decompressed the patient volume due to the threat of Hurricane Irene. Even then we charged the nursing home for our services. In turn the nursing home sought relief from FEMA.

Another issue we ran into is taking care of nursing home evacuees from facilities in South Jersey. many of these patients were transported without their medical records nor a list of medications. Many couldn't even tell us the name of their medication because when in a nursing home someone came at the appointed time and told them to take X, Y, and Z. Fortunately these patients were not transported directly to our hospital but when the reach the college facility they were using as a shelter (BTW had no medical services available) they were subsequently transport to the hospital because of medical issues. One patient had a history of a stroke that left him without the ability to speak, making a chance of getting even something as simple as a name a hardship.

Combine all these issues into a hospital that had a very small margin of staffing to beds, an overcrowded ED even on the best of days. Pease remember, first and foremost, hospitals is an acute care facility providing healthcare for patients. As such, the hospital's resources are already committed to those who need them most, and the hospital is not equipped to act as a shelter during a disaster.

[helicopper 1,050]

A couple of questions on the subject that would have to be answered by each individual hospital...

1. Do the hospitals have adequate space to serve as a shelter in addition to their day to day obligations?

2. Who will staff them? Who will pay for the staffing?

3. Can they be properly secured with shelter population segregated from hospital population?

4. Is the infrastructure capable of supporting the expanded population (bathrooms, kitchen, sleeping space, parking, generator(s), etc)?

Aside from ventilator patients or those in need of medical support, I don't think it's such a great idea. I don't think firehouses should be used as shelters either. These locations have enough to do in an emergency without compounding their responsibilities with sheltering.

Just my two cents...

[SageVigiles 1,194]

The logistical and administrative issues that go with a NORMAL shelter are staggering, using a hospital would be a complete nightmare. We mostly use schools up here in CT since they USUALLY have generators and are normally closed for business during a significant event anyway.

Many emergency shelters in south-central CT are staffed by Community Emergency Response Team (CERT) members, Medical Reserve Corps (MRC) members (this includes nurses, etc since a shelter is required to have a nurse,) the Fire Department (for "firewatch") and the Police Department, including their Animal Control Officers for pet sheltering if the State Animal Response Team is not utilized or available. Obviously Board of Ed personnel are present for building issues and to provide food in the cafeteria. During Irene I know West Haven also utilized the Fire Explorers to assist the CERT people with some of the logistics involved in the shelter operation.

Some south-central towns use Red Cross to manage their shelters, some do not. Their policies and procedures sometimes don't jive with what the towns are looking for. There is also a discussion of regionalizing shelters in New Haven County AKA CT Region 2 so that resources don't get so spread out. Only issue with that is the logistics of moving people from one city to the other and back in a disaster.

[ny10570 745]

We're getting away from the article here. In this case the hospital was turning away people who needed medical care unavailable at your typical shelter.

[SageVigiles 1,194]

We're getting away from the article here. In this case the hospital was turning away people who needed medical care unavailable at your typical shelter.

How much of it was really unavailable at a local shelter though? Local Health Departments should have the necessary capability to refrigerate medications, as should any school with a cafeteria. Medical devices that need to be charged can also be taken care of at a normal shelter with a generator. Milford and West Haven did it when we had no power for a week post-Irene. Again, use of an MRC with trained and licensed medical professionals can really step up the abilities of your shelter to provide basic care and keep the hospitals (and EMS agencies who might have to transport them there) from getting overcrowded with non-emergency patients.

Ventilators and O2 patients are always an issue, because the Oxygen delivery companies are getting flurries of panicked calls regarding refills, etc.

[NWFDMedic 58]

As the number of people without family support systems in this area increases, this problem will just continue to grow. Shelters must be predefined and available and a plan must be in place on how to request and activate the shelter. Hospitals are not the best option for these patients as they are generally at high census during these storms anyway. Many hospitals only have generators to sustain minimum functions and when you add in the potential greater workload of patients that undergo regular outpatient procedures (i.e. dialysis) that may need to come to the hospital instead of an outside center, the infrastructure of the hospital is a major concern in addition to space and staffing. Schools would be a good choice except I don't know of one school in my area that has a backup generator.

[ny10570 745]

How much of it was really unavailable at a local shelter though? Local Health Departments should have the necessary capability to refrigerate medications, as should any school with a cafeteria. Medical devices that need to be charged can also be taken care of at a normal shelter with a generator. Milford and West Haven did it when we had no power for a week post-Irene. Again, use of an MRC with trained and licensed medical professionals can really step up the abilities of your shelter to provide basic care and keep the hospitals (and EMS agencies who might have to transport them there) from getting overcrowded with non-emergency patients.

Ventilators and O2 patients are always an issue, because the Oxygen delivery companies are getting flurries of panicked calls regarding refills, etc.

Who is in charge of that refrigerator? Is it secure? Does it have enough space? How many outlets does the school gym or firehouse have? People need to charge cell phones, agencies need computers, etc. How reliable is and how much capacity does the shelter's emergency power supply have? How are you going to get these non-ambulatory patients to the proper destination? These are issues applicable everywhere and should have been addressed long ago. From the hospitals to the EMS agencies. These people have to go somewhere and hoping the local ER can take them is no more appropriate than telling them, sorry you're not an emergency yet call back later.

[SageVigiles 1,194]

Who is in charge of that refrigerator? Is it secure? Does it have enough space? How many outlets does the school gym or firehouse have? People need to charge cell phones, agencies need computers, etc. How reliable is and how much capacity does the shelter's emergency power supply have? How are you going to get these non-ambulatory patients to the proper destination? These are issues applicable everywhere and should have been addressed long ago. From the hospitals to the EMS agencies. These people have to go somewhere and hoping the local ER can take them is no more appropriate than telling them, sorry you're not an emergency yet call back later.

Well that's the whole point of having an emergency operations plan and exercising it. The best plan in the world means nothing if its not practiced. Those issues need to be worked out BEFORE the incident so you can figure out the logistics, so I agree with you on that point for sure.

[PEMO3 523]

Many issues that come up with the latest round of storms are patients with life sustaining equipment (LSE) and utility companies response and priorities. The response that many customers received from their utility company when their portable oxygen supplies started to run low was to dial 911 and go to the emergency room. While it is understandable that large scale outages taxes resources one does wonder why utilities lull customers into that false sense of security telling them to advise them if they are a "special needs" customer with LSEs so that they can "be there for them" then listing them with everyone else on the long list of restorations. Dragging these customers to local EDs and overcrowding and taxing their resources does not help the situation either. Frequently these facilities are already working short staffed due to the storms/event with staff that is already on overtime. Compounding that with grandma that needs an outlet for her oxygen and forgot her meds at home on her dresser, and junior in tow who wants to charge his cellphone and both looking for food and a blanket is not going to help the situation. Shelters themselves do not solve the problem unless the facility has a existing generator and then the question of capacity comes into play. We all remember New Orleans and Katrina. Even the Superdome was no answer. The best answer for many may be self sufficiency. Small portable generators or battery backups to run the LSE equipment for a period of time when the need arises. While the Halloween storm was hopefully an exception to the rule most power outages are restored in a 24 to 36 hour period.

[efdcapt115 1,511]

Short answer, no. Schools would be better, gymnasiums, easier to keep track of people coming and going. Communities should pre-plan; preposition adequate resources: cots, electric strips, MRE's. There's plenty of room.

Down this way, Monroe County (which consists largely of The Keys) has an emergency shelter up on the mainland in Miami-Dade, with adequate signage to direct residents who wish to stay there, how to get there. With hurricanes being the major threat, they've had plenty of experience in preparing for evacuations. They even have "re-entry" stickers for your vehicle; the furthest West are a #1 for re-entry, middle Keys #2, upper Keys #3. Easy way for LE to allow folks back in who belong here, and keep bad guys from coming in. It's also made easier when you only have one road in.

[fireboyny 61]

We're getting away from the article here. In this case the hospital was turning away people who needed medical care unavailable at your typical shelter.

I don't see anything wrong with hospitals truing people away if the resources are not adequite enough to handle the situation. They need to follow some sort of priority system.

[Guest alsfirefighter]

Who is in charge of that refrigerator? Is it secure? Does it have enough space? How many outlets does the school gym or firehouse have? People need to charge cell phones, agencies need computers, etc. How reliable is and how much capacity does the shelter's emergency power supply have? How are you going to get these non-ambulatory patients to the proper destination? These are issues applicable everywhere and should have been addressed long ago. From the hospitals to the EMS agencies. These people have to go somewhere and hoping the local ER can take them is no more appropriate than telling them, sorry you're not an emergency yet call back later.

Most shelters when talking about a large amount of people would have some form of medical support there. And if its an emergency shelter what does it matter who's in charge of the refrigerator...If I'm in charge of the medical aspect of the shelter...guess what...I now am. this is also why they tell people during some storms to have a supply of meds available and organizing refrigerated meds to me is not all that difficult. While people may have to go somewhere, over crowding a hospital full of actual sick people isn't necessarily the best way and the security of the facility and well being of actual sick people is a priority. And if call volume gets that high during an significant emergency..guess what in some cases your basically telling them you're not an emergency we will get to you when we can. Prime example is most places that deal with tropical storms and hurricanes stop responses when winds hit a certain speed.