Shelter Medical Services Primer

By Alexander Isakov, MD MPH and Eric Ossmann, MD
Section of Prehospital and Disaster Medicine
Department of Emergency Medicine
Emory University

Shelters organized by the American Red Cross, the Salvation Army and others are housing a proportion of the displaced population from the coastal states. These organizations have the capacity to provide many necessary services, but do not have a formal capacity to provide medical care. Evacuees who have been displaced from their usual access to health care services, and who may face a prolonged absence from those services are at risk for having their medical conditions deteriorate for lack of medications, medical supplies, or access to vital medical services.

The development of acute medical conditions by evacuees may increase the volume of patients seeking care in already strained emergency departments. In the absence of access to community health centers, primary care clinics and pharmacies, evacuees may seek solutions to their low-intensity medical needs from the emergency department, threatening to further congest the emergency medical services system.

This primer yields from the experience of tending to the healthcare needs of a large population displaced from their homes for an indefinite period to a large metropolitan community with an intact, but routinely strained medical infrastructure.

Displaced population routinely present with the following medical needs:

  • Medication prescriptions and medications
  • Medical supplies – crutches, canes, wheelchairs, glucometers, test strips, reading glasses
  • Urgent care complaints – URI, GI symptoms, rash
  • Need for referral to primary care – prenatal, pediatric, adult
  • Need for referral to urgent specialty referral – psychiatry, oncology, transplant

Means for individuals to have these immediate medical needs addressed:

  • Volunteer on-site shelter health care services
    • Ideally focusing on the "residents" of the shelter
  • Community health centers/primary care clinics/pharmacies in the immediate vicinity of the shelter
    • Ideally referring the "non-shelter evacuee" who presents to the shelter seeking health services
  • Local emergency departments
    • Reserved for the acutely ill requiring "emergent" intervention or need for admission to an acute care facility

Health care services provided at the shelters are very valuable. Providers attend to the "low-intensity" but critical needs of the population, providing essential prescriptions and medications which prevent individuals from getting acutely ill or flooding hospital emergency departments for their primary care needs.

  • Challenges arise when providing health services at the shelter:
  • On-site or close collaboration with a pharmacy is essential
  • Establishment of medical services at a shelter invites a large number of non-shelter residents seeking care at the facility creating crowding and congestion resulting in logistics and security challenges
  • Individuals are still in need of primary care and specialty follow-up

Congestion at the shelter created by individuals seeking health care services can be alleviated by referral to existing, near-by community health centers and clinics. To facilitate this:

  • Create informational hand-outs which identify the near-by community health centers and pharmacies which includes
    • Name
    • Address
    • Phone number
    • Services offered (on-site pharmacy, OB, peds)
    • Hours of operation
    • Printed MAPQUEST instructions from the site if possible
  • Arrange transportation for those who require it to shuttle patients to the community health centers and clinics
    • Salvation Army van pool
    • University van pool
    • Medical Center van pool
  • Coordination with the community health centers and clinics is essential to ensure adequate staffing for the anticipated volume

Suggestions for Provision of Shelter Health Services

Staffing (experience is for shelter with 100 occupants):

  • Physician (2) – attending and resident
    • Physicians must be prepared to address urgent care and primary care concerns
  • Nurse (2)
  • Pharmacist (2) –  essential for provision of medications
    • PharmD -  to allow for collaborative practice procedures
    • Pharmacist - to pass out medications
      If pharmacy staff are not available for the on-site operation, referral to local pharmacies, and knowledge about their capacity to fill prescriptions on a pro bono basis, hours of operation and possibly transportation to that pharmacy for those without vehicles will be important
  • Registration (2)
    • Staff to register patients into a particular health system in order to facilitate physician referrals, dispensing of medications or acquisition of durable goods or simply to record desired intake information which will be helpful for epidemiological purposes, patient tracking, and refining of the staffing model

Supplies:

  • Tools - Stethescope, blood pressure cuff, glucometer with test strips, urine dip stick, tongue depressor, flashlight (light source), bandages/band-aids/dressings, prescription pads
  • On-site medications – insulin, starter quantity of oral hypoglycemics (Metformin), starter quantity of oral antibiotics (Keflex), starter quantity of antihypertensives (Lisinopril), NSAIDS, decongestants, bronchodilator MDI, topical antibiotics, anti-fungals and steroids
  • Durable medical supplies – mechanism for arranging for wheelchairs, canes, crutches, walkers

Referral Resources:

  • Means for non-urgent primary care and specialty referrals
    • OB
    • Pediatrics
    • Psychiatric and Mental Health
    • Oncology
    • Transplant
    • Podiatry
    • Dental

Many may be accomplished by establishing an urgent referral process with local medical centers or flyers indicating available local community health care centers. Depending on location of facility, referral numbers for local health center resources will be most appropriate.

  • Means for urgent (non-emergent) specialty referral – requires communication with specialty clinic scheduling resources with capacity to schedule and overbook specialty clinic referrals
  • FOR EMERGENT CASES - Access to the 911 EMS system
    • Identify a land line (this will allow for automatic transmission of the address to the public safety answering point)
    • Know the address and return phone number
    • Know to which entrance you will be directing the ambulance
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