Design a poster as a public service announcement

  

Course title: Public health implication of disastersAssignment:Design a poster as a public service announcement focused on any aspect of special populations during disasters. This is the chance for you to think creatively as well as to showcase any artistic ability you have.I have attached 3 good resources that will help you build your idea for the PSA, and here is a list of great resources too:1. Ciottone chapters 9, 10, and 584. Landesman chapter 8: Behavioral Health Strategies5. Landesman chapter 11: People with Disabilities and Others With Access and Functional Needs6. Landesman: chapter 15: Ethical Considerations in Public Health Emergencies7. Wisner chapter 6
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The American Journal of Medicine (2006) 119, 986-992
CLINICAL RESEARCH STUDY
A Katrina Experience: Lessons Learned
Mary Currier, MD, MPH, Deborah S. King, PharmD, Marion R. Wofford, MD, MPH, Bethany J. Daniel, BS,
Richard deShazo, MD
Department of Medicine, University of Mississippi Medical Center, Jackson, Miss.
ABSTRACT
PURPOSE: Almost no data exist on how best to respond to the medical needs of civilians displaced by
natural disasters. After Hurricane Katrina destroyed the Gulf Coast and seriously damaged the infrastructure of Jackson, Miss, the University of Mississippi Medical Center (UMMC) was challenged with serving
a large group of evacuees at a major Red Cross evacuation shelter near our campus. We reviewed our
experiences and share lessons learned.
METHODS: This is a retrospective review of administrative and clinical records for patients served by a
medical clinic established emergently after Hurricane Katrina.
RESULTS: Red Cross regulations precluded their volunteers from providing medical care other than first
aid. Faced with numerous evacuees seeking medical assistance, UMMC established an ambulatory clinic
at the shelter. The majority of patients had multiple medical problems, no medical insurance, and limited
ability to purchase medications. The greatest need was for management of chronic illnesses. The clinic
provided 2394 patient visits and filled more than 4902 prescriptions over 17 days.
CONCLUSION: While medical facilities have emergency response plans for epidemics and mass trauma,
little attention has focused on plans for care of evacuated populations. Shelter operators should consider
advance coordination of medical care with existing health care systems. Medical facilities along evacuation
routes should be aware that they may be asked to provide care for sheltered evacuees. © 2006 Elsevier Inc.
All rights reserved.
KEYWORDS: Emergency preparedness; Natural disasters; Chronic disease; Disaster plans
On August 29, 2005, Hurricane Katrina made landfall on
the Gulf Coast as a Category 4 storm. Orders were issued
for evacuation of the Gulf Coast counties on August 27-28,
2005.1 Interstate 55, originating in New Orleans, La, and
US Highway 49, originating in Gulfport, Miss, brought
thousands of evacuees to Jackson, Miss, the state capital,
180 miles due north of the Gulf of Mexico. On August 27,
the American Red Cross opened a hurricane evacuation
shelter in the 10,000-seat, 6237 square meter (67,140 square
foot) Mississippi Coliseum and the adjacent 2364 square
meter (25,449 square foot) Mississippi Trade Mart at the
Mississippi State Fairgrounds in Jackson.2 These facilities
This work was supported by the Department of Medicine, University of
Mississippi Medical Center.
Requests for reprints should be addressed to Mary Currier, MD, Department of Medicine, University of Mississippi Medical Center, 2500
North State Street, Jackson, MS 39216.
E-mail address: mmcurrier@medicine.umsmed.edu.
0002-9343/$ -see front matter © 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.amjmed.2006.08.021
rapidly filled with evacuees from Mississippi and Louisiana,
peaked at a population of over 1600 the first week, and
remained open until September 15, 2005.
During the afternoon of August 29, Katrina came north
through Jackson, and the city experienced sustained winds
of 63 miles per hour, with gusts of 84 miles per hour.3 The
winds caused significant infrastructure damage with widespread power, telephone, and cell phone outages lasting
from days to more than 2 weeks.4,5 The University of
Mississippi Medical Center (UMMC) disaster plan was activated to receive casualties from the south, while automobile gas shortages developed as few service stations had
electric power and fuel deliveries were interrupted.6
The UMMC, Mississippi’s only academic health center,
is composed of 7 hospitals located approximately 3 miles
from the Mississippi State Fairgrounds. Physicians quickly
became aware of the presence of large numbers of chronically ill evacuees as they began to present to area emer-
Currier et al
Hurricane Katrina
987
based searches of the medical literature published in English
gency rooms. We also discovered that American Red Cross
were used in our attempt to identify models to guide the
evacuation shelters provide basic first aid for shelter residevelopment of our response.
dents and refer all other medical care to community health
care providers.7 To provide care for the evacuees and to
conserve existing medical facilities for acutely injured inRESULTS
dividuals, we organized and
The clinic medical, pharmacy, and
staffed a free health care clinic at
administrative directors mobilized
the evacuation shelter from AuCLINICAL SIGNIFICANCE
a large team of volunteers and
gust 30 until September 17, 2005
worked continuously to improve
(Figure 1). In this article, we de● No published guidelines exist for develthe efficiency of relief efforts. The
scribe our experience with the oroping a medical care system for shelclinic registered patients from
ganization, staffing, and administered populations during natural
1 PM to 3 PM and was open to
tration of this facility.
disasters.
complete care for at least another
hour daily. Staff meetings took
● Medical centers, especially academic
place before and after each clinic.
METHODS
medical centers, should be prepared to
The Red Cross coordinated secuOn August 30, 2005, the Chair of
provide chronic disease care, including
rity with local law enforcement, as
the Department of Medicine
medications, for sheltered individuals
well as the National Guard. Modcalled a meeting to organize the
during natural disasters.
ifications in the scope of service
department’s response to the hurand location of clinic operations
ricane. Among other actions, a
● This article should be a guide for planwere required each day as circumphysician team was dispatched to
ning and preparedness.
stances and patient populations
the Red Cross shelter at the Misconstantly changed.
sissippi State Fairgrounds to assess needs and resources. The urgent need for onsite medical services was identified, and
permission was obtained from the shelter supervisor to
establish a clinic. The department chair appointed a physician with experience in public health to serve as the medical
director, a doctor of pharmacy with mission experience to
serve as the pharmacy director, and an administrator with
experience in clinical services to serve as the administrator
of what came to be called the “Katrina Clinic.” We reviewed clinic notes, e-mails, patient encounter and pharmacy records, photographs, newspaper articles, and American Red Cross operational manuals in the preparation of
this report. Patient encounter records were entered into a
Microsoft Access database, and analyzed in Microsoft Excel
(Microsoft Corporation, Redmond, Washington). Computer-
Figure 1
Communications Issues
Telephone outages were expected after the hurricane, but
we did not anticipate that damage to cell phone towers
would result in limited and unpredictable cell phone service.
The hospitals functioned on “weekend staffing” schedules
because many employees were initially unable to reach their
work places because of damage to their homes and blocked
roads. Fortunately, the number of Emergency Department
patients needing treatment for acute injuries was fewer than
expected.
Functional e-mail within the medical center provided a
mechanism for rapid recruitment of volunteers and for clinic
organization. A single administrative assistant was given
the task of compiling a list of potential personnel classified
Chronology of Katrina-related activities.
988
The American Journal of Medicine, Vol 119, No 11, November 2006
by profession and level of expertise along with appropriate
contact information. More than 375 individuals from our
campus, local communities, and later, from out-of-state,
volunteered to help during this period.
Clinical Services
Providers. The clinic directors identified individuals in
adult and pediatric primary care, pharmacy, nursing, and
administrative services to coordinate volunteers in their
respective areas. Other needs such as dental, psychiatric,
obstetric, dialysis, and asthma care services became apparent as the clinic progressed, and volunteer coordinators were
assigned in these fields as well. Clinical volunteers were
required to have active medical licensure or to be trainees
enrolled in professional programs at the Medical Center. We
were able to include out-of-state physicians and nurses in
our clinic operations, as state law allows physicians and
nurses with licenses in other Emergency Management Assistance Compact member-states to be deemed licensed in
Mississippi.8
Although the original plan was to operate the Katrina
Clinic for a week or less, many evacuees were unable to
return to their homes and interim care had to be provided
until long-term health care arrangements could be made.
Cooperation was sought from local, federally funded community health clinics that were in a position to provide
long-term care, regardless of ability to pay. Transportation
to those clinics was arranged by Red Cross volunteers,
largely through local churches and individuals with vans or
buses. Medical professionals opened several small medical
shelters at local churches during the second week of September. These allowed us to refer some chronically ill patients and families with pregnant women to a more medically secure environment.
Clinical Operations
Space. Fortunately, electrical power remained on at the shelter
and at UMMC while most of the city and region experienced
outages. When the Katrina Clinic opened, the original space
occupied for medical evaluation was 320 square meters (3447
square feet), curtained off from the living space of the evacuees. The pharmacy was housed in a large recreational vehicle
(RV). Clinic and pharmacy services were eventually moved to
secure space within the shelter.
Supplies. We developed a simple but specific list of
supplies required for daily operation (Table 1). The shelter
initially experienced difficulties locating enough electrical
outlets to power continuous positive pressure devices
(CPAP), nebulizers, and oxygen concentration machines.
This problem was rapidly identified and alleviated by Red
Cross personnel working with facility staff.
Daily Staffing. The Red Cross leadership was unclear
how long the shelter would be open. For this reason, the
administrative director and administrative volunteers developed job titles and descriptions and used this information to
develop a list of prospective volunteers needed to operate
Table 1
Suggested Supplies for a Shelter Medical Clinic
Administrative Filing system
Maps and written directions for patients
Medical and pharmacy forms
Paper, pens, staplers, scissors
Signage
Tables and chairs
Xerox machine, facsimile machine, computers
with printer, telephone lines, cellular
telephones
Medical
Blood pressure cuffs (all sizes)
Disposable sheets and gowns
Examination tables and disposable covers
Gloves, wipes, alcohol pads, hand sanitizers
Glucometers and supplies
Local anesthetics
Nebulizers and tubing
Needles and syringes (including vaccines
syringes)
Otoscopes and pen lights
Prescription pads
Soap and antiseptics to clean wounds
Suture kits
Thermometers and thermometer covers
Tongue blades
Sharps containers
Wheelchairs, crutches, walkers
each service on an ongoing basis (Table 2). Although the
clinic operated for 3 hours each day, many volunteers were
needed to organize and re-supply the clinic and pharmacy
before and after the clinic hours.
A threat to the clinic staffing occurred when gasoline
became limited shortly after the hurricane.6 Leadership at
UMMC were able to secure gasoline from another region
and to establish a supply system for medical center employees. This became available on September 6 and remained
operative until September 27. Additionally, medical center
administration established a temporary daycare service for
employees with children, as most schools and daycare centers were closed.
Medical Records. An encounter form was developed
and revised as needed over time. There were 2394 patients
cared for in the clinic and of those, 2299 had records
available for analysis. Forty-three percent of the patients
were triaged to the pharmacy unit only, 55% were triaged to
the medical unit, and 2% received dental care. The majority
of patients (78%) seen in the medical unit also received
prescriptions. The average patient age was 40.6 years, 15%
were children 18 years of age or younger and 10% were
adults aged 65 years or older. Most of the population were
African-American and 62% were female (Figure 2). Of the
1696 patients for whom home state was listed, 79% were
from Louisiana and 20% were from Mississippi. Of the
1142 patients with medical insurance information recorded,
23% had private insurance, 13% had Medicaid, 10% had
Medicare, 1% had both Medicaid and Medicare, and 53%
Currier et al
Table 2
Hurricane Katrina
989
Job Titles and Descriptions of Personnel for the Katrina Clinic
Personnel
Administrative*
Administrative Director
Clinic Manager
Registration
Runner
Discharge Assistants
Medical
Medical Director
Medical personnel
Nursing personnel
Pharmacy
Duties
Oversees operation/implementation of administrative functions
Coordinates with UMMC main campus
Coordinates with shelter manager
Oversees set up of clinic
Assigns personnel to administrative functions
Recruits and schedules volunteers
Collects volunteer licensure documentation
Registers volunteers/maintain volunteer database
Coordinates EMS/ambulance and other transportation
Collects demographics and insurance information
Witnesses consent to treatment signature
Performs miscellaneous duties (patient direction, run errands, assist in clinic organization)
Collects and files patient forms
Distributes maps/directions
Reviews set-up with Administrative Director before clinic opening
Assigns medical team leaders
Troubleshoots as needed in all phases of medical evaluation
Serves as liaison with other medical facilities, and volunteer agencies/hospitals/clinics and
personnel
Serves as media spokesperson for clinic
Examine and evaluate patients
Administer or initiate treatment
Write prescriptions for pharmacy-only patients
Obtain vital signs
Assess chief complaint
Obtain medication list and allergies
Note any special needs
Triage to appropriate medical evaluation station (general medical, pediatric, asthma treatment,
dental, mental health, obstetrics, etc.)
Fill prescriptions with donated medicines (substituting as needed)
Solicit and organize medication donations
Ensure security of medications during and outside of clinic hours
Educate patients on use of medications
Update clinicians on current medication stock, etc.
Procure pharmaceuticals
*We suggest a Director of Procurement be added (see text).
had no insurance. For those with no insurance information
recorded, it is reasonable to estimate that most had no
medical insurance. Therefore, approximately three fourths
of the patients were uninsured. The shelter population continuously fluctuated as new evacuees arrived and others
went to smaller shelters, friend’s homes, or hotels. The
number of evacuees in the shelter had little impact on the
number of patients seen in the Katrina Clinic (Figure 3).
Pharmacy Services. Most patients seen in the Katrina
Clinic needed prescription medications. Many of the hurricane evacuees left the Gulf Coast with only enough prescription medications to last for a day or 2. Our first tasks
were to write prescriptions, identify the few pharmacies that
were open to fill them, and to obtain medications for those
who could not pay. On August 30, UMMC opened a temporary prescription refill service on the main campus using
sample drugs from pharmaceutical representatives and phy-
sician offices. The Katrina Clinic and Pharmacy opened at
the shelter on September 1 (Figure 1) and absorbed the
campus operation.
The onsite pharmacy at the Katrina Clinic was staffed
with licensed pharmacists and other volunteers. Storage and
security of large quantities of donated drugs, which arrived
daily, and separation of useful and in-date drugs from less
useful or outdated ones, required a large secure space and
coordination of many volunteers.
The onsite pharmacy operated for 17 days and filled
more than 4902 prescriptions. The number of recorded
prescriptions filled (4902) is a gross underestimate, as many
people had prescriptions written, but not recorded on the
medical record form. Originally, we dispensed a 14-day
supply of medications but realized this would not meet the
needs of this population. Therefore, when possible, a 30-day
supply was provided. Another challenge included the length
990
The American Journal of Medicine, Vol 119, No 11, November 2006
Figure 2 Evacuees in the living area of the Red Cross shelter the Jackson, Mississippi Coliseum on the state fairgrounds, September 2005.
Photo courtesy of the Clarion Ledger and used with permission.
of time it took to acquire the most needed medications and
supplies for chronic diseases (Table 3), as these medications
are not typically stocked in warehouses or coordinating
centers for disaster response. As the scope of the disaster
became clear and many residents realized they no longer
had homes to which to return, medications for depression,
anxiety, and other psychiatric disorders were increasingly
requested. The initial need for antibiotic, antifungal, and
antiparasitic agents was low but also increased over time.
For certain needs, such as antiretroviral drugs, dialysis, or
methadone therapy, arrangements were made for referral to
clinics or physicians identified by the clinic staff. Americares (Stamford, CT) and MAP International (Brunswick,
GA), along with several pharmaceutical companies, played
a vital role in organizing and obtaining the contributions of
medications needed for this population.
Assistance was also requested and obtained from local
retail pharmacies. Wal-Mart and Walgreen Pharmacies
joined the clinic operation at the shelter. They were especially helpful in providing generic medications, which were
Figure 3 Number of Katrina Clinic patients and onsite sheltered
evacuees by day, September 2005.
in short supply among the donated drugs. Their representatives received prescriptions onsite, filled the prescription at
their local retail sites, and delivered them back for dispensing at the shelter at a minimal or no cost to the patient.
DISCUSSION
Hurricane Katrina posed challenges and opportunities for
our academic health center. A large number of evacuees
with chronic medical conditions and few resources were
Table 3
Clinic
Medication Categories Prescribed at the Katrina
Medication Category
Number (%) Prescribed
Cardiovascular*
1512 (30.8)
Antihistamine/decongestants
490 (10.0)
Psychotropic†
437 (8.9)
Analgesics
430 (8.8)
Diabetes
390 (8.0)
Asthma
360 (7.3)
Tetanus/diphtheria vaccine
305 (6.2)
Antibiotics
284 (5.8)
Gastrointestinal drugs
237 (4.8)
Sleep aids
79 (1.6)
Local antibiotic and steroid creams‡
73 (1.5)
Antiepileptics
62 (1.3)
Birth control pills
35 (0.7)
Muscle relaxers
28 (0.6)
Osteoporosis
21 (0.4)
Miscellaneous other
159 (3.2)
Total
4902 (100)
*Largely antihypertensives, but also medications for heart failure,
dyslypidemia and arrhythmia.
†Largely antidepressants but also antipsychotics and anxiolytics.
‡An underestimate as most creams and ointments that were distributed were without a prescription and therefore not recorded.
Currier et al
Table 4
Hurricane Katrina
Important Contacts for Planning
Academic Medical
Center Contacts
For clinic organization
and cooperation
For patient referral
For supplies and
assistance
Upper level administration
Departmental Chairmen
Point persons for staffing
Medical
Nursing
Pharmacy
Administration
Social work
Campus Police …
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