Medical Special Needs Sheltering At The University of Texas at Tyler's Patriot Center

State: TX Type: Model Practice Year: 2009

The goal is to provide a safe and secure facility to shelter 200 persons who are unable to meet their daily medical needs. During previous evacuations the medical community was overwhelmed with a surge in patients seeking treatment for chronic conditions. The creation of the MSN shelter was in response to a need to protect the medical infrastructure of the community and access to care for local residents. The Patriot Center is capable of providing 200 Medical Special Needs Patients a safe and secure facility to shelter evacuees.
This addresses the public’s access to care and emergency preparedness issues. Community After Action Reports identified these issues from the response to Hurricanes Katrina and Rita. MSN shelters were opened without planning before these events. The medical community was able to respond but had to limit access to the local community and evacuees. Delivery of primary care and sufficiency of care is provided at the MSN shelters instead of the hospital and clinics in our community. There are numerous plans from state and local entities that address the establishment and operation of MSN shelters. The partners that make up the elements of the MSN shelter differ in that the partnership is made up of public and private organizations. The shelter exists as part of Emergency Management’s response to an incident. We believe the practice is unique in that the other models describe the operations of these types of shelters. Our practice describes the way NETPHD organized and directed the community stakeholders in solving a threat to access to care providing an effective response during an emergency.
Agency Community RolesNETPHD’s role is to provide coordination and control as an agent for the Emergency Management Officials of Tyler and Smith counties. Under the direction of the County Medical Authority, NETPHD can direct the proper response from first responders and receivers. Emergency Management is the coordination and control directors. Its role is to direct the response to an event. NETPHD’s role is to liaison between Emergency Management and the other stakeholders. NETPHD also works to build the roles and responsibilities of the stakeholders. The RAC provides the funding for infrastructure, training, and supplies. It also provides the framework for the Medical Operations Center (MOC) that directs the medical response to an event that affects the community. The hospital community, which makes up the RAC, staffs the MOC. They contribute the funding for the MSN shelter for its operation. The University of Texas at Tyler provides the staff and facility to operate the shelter. NETPHD does the planning, within the state and local framework, for the for the stakeholders. We also provide access to training and funding. NETPHD organizes and provides volunteers through the Medical Reserve Corps to help operate other MSN shelters including Patriot Center. Costs and ExpendituresBack up electrical generator and interface, $35,000; Shelter Supplies, $140,000; Supply storage, $1,400/month; Operations, building repair and cleaning, variable. ImplementationNortheast Public Health District (NETPHD) recruited the nursing department at the University of Texas at Tyler to organize a MSN shelter operations team in an ICS/NIMS compliant structure. A Memorandum of Understanding was signed with the University to secure the Patriot Center complex for use as a shelter. Facility upgrades, such as electrical connects and Internet access, were identified and completed. Supplies needed for operations were identified and purchased. Training was provided for staff. Storage facilities for supplies were found. Local stakeholders exercised with inventory and lines of communications to familiarize operators with procedures to open a MSN shelter. The need was identified in late 2005 and tasks were complete by December 2006.
Acuity levels were higher than described in the state planning documents that specifies what conditions are appropriate for a MSN shelter. Increases to current inventories and addition of items such as beds with 1,000-pound capacities. Urinary catheters, glucometers, oxygen accessory supplies and wound care kits are other examples of items that needed to be added or increased for the shelter. Feeding was done from a volunteer agency. A need was identified during satisfaction surveys that a more robust method was needed to provide meals for patients with dietary restrictions. Currently a contract with a private vendor is being pursued. An effort to provide care at general population shelters was organized to further protect the local infrastructure.
NETPHD believes that the commitment to sustain the involvement of the stakeholders remains high. This is demonstrated in the ongoing training participation and monies spent to replenish inventories. Currently there is a long-term agreement being constructed to ensure that the facility remains available for use. The City of Tyler and the University are working on a long-term agreement to ensure a commitment from all parties make the shelter a sustainable practice. Details such as liability and funding will be defined to more accurately describe the operation. Issues such as recovery and fatigue will be addressed so the the University will be guaranteed adequate time to recover after an event. Organizational planning is ongoing to meet issues identified during after action reports. Leadership and participation is being addressed by training and education.