NC FAST Sustainment Training State Medical Support Shelters 20191121 1809 1On December 6, 2019 by Raul Dinwiddie
Welcome! Please a reminder if you are not speaking, please put your phones or your headsets on mute. I want to welcome Nicholas Thorpe from CapRAC and he’ll explain a little bit more about what that is. He is an original, FAST team member. He took his training under Wendy Pulley when she started the FAST program here, and he’s been a very interested member and a very good supporter of our program. So he is here to talk about. The state medical support shelters and what they’re all about and how FAST can best integrate with them So, good, I guess just good afternoon again. Sorry for my technical difficulties on my side even after we sort of practice this. I’m a, I’m actually currently down at Campbell University, attending a public health and preparedness Ebola tabletop exercise. So, I’m doing this a little bit remotely, but yeah, I’m the emergency planning and exercise specialist with the capital or the CapRAC healthcare preparedness coalition and hopefully through this presentation. We can work to identify or increase our knowledge on on how the state, and how coalitions support the state and providing special medical support shelters during crisis and hopefully identify roles that FAST team members can support in these operations. And sort of what the expectations are, or should be for FAST team members if they are deployed to provide assistance. So feel free to engage on in questions I’ll answer as I’m able to. But hopefully, with this, we will have a good discussion. And I do apologize for any background noise again. I’m at a college campus right now, so let’s jump in and hopefully this, why will change for me? It was all right here we go. So, today we’re gonna be talking about, em, again, the thing medical response system. That’s where the bigger picture of of how the state manages the medical Pre hospital care and disaster preparedness for the healthcare infrastructure. We’ll talk about the role, the healthcare preparedness coalition tab in the state, and how you can get engaged with your coalitions when we’ll specifically talk about the technical assistance teams in the Medical Reserve Corps. Those are the volunteer and operational arms of the coalition. And then we’ll wrap this up with what you think medical support shelter is, what it does and how FAST team members can support those missions as they occur. So the state medical response system, the state medical response system is part of the North Carolina trauma system that is supervised And the oversight agency is the North Carolina office of emergency medical services, or through this process. And within the trauma system, they our support for all Pre hospital care, transport operations, trauma, related programs and disaster preparedness and response activities. And so this is pretty much how if you had a traumatic injury how it’s governed. What hospital you are going to end up at. And so this is something that has been working on four years. Now. So, within this trauma system, and this trauma system concept, and under that branch of public health or our healthcare preparedness, you get the state medical response system. And that’s how all these different entities. Public Health healthcare coalition emergency management is how we all come together to solve the problems related to the health care infrastructure in the state. And of course, they just started mowing the grass next. Alright. So all these systems are, they live within the trauma. This is a Sheri, can you please put your phones, and you headsets on mute, thanks. Was that that’s such an impact on everyone. Alright, I think I think that resolved it. Nicholas, Hello. Nicholas. Can you hear me? Hello? Hello? Hello? Hello? There we go. I can hear you all right. So the statement of response system is similar to what you would see within, like, the citizen core program that manages cert and it’s that same concept. So, within this SMRS system, you get eight state, eight, regional state, medical assistance teams, and they mirror, they’re very similar to the DMAT teams to disaster medical assistance teams at the federal level. So, we sort of this program sort of, matches them at the federal level. And they have these four primary missions, and as the support the medical support shelters, which we’re talking about today, field medical care. So that’s, you know, a response to special events or public health emergencies within the community, provide logistical support to, to support the healthcare infrastructure. So that could be anything from direct resources, subject matter expertise, supplies and equipment to support the medical needs of the community and, and alternate care sites that is tied to our mobile disaster hospital capabilities. And I might have to move as this lawn mower gets close to me, so I’m trying to hopefully you guys can still hear me. All right. So, within the trauma system in the regions, they break it up based on the level one and level two trauma centers. So, here in North Carolina, we have eight level one, level two trauma centers. So that means we have eight medical assistance teams. They are responsible for that region of counties to, to coordinate the, these responsibilities, trauma care, transport, transportation, related education. And then this is where I live is to facilitate the healthcare preparedness coalitions. So, instead of coming up with a new map, and new way for the state to be broken into, in terms of, in terms of preparedness, they decided to just contract with these level one level, level two trauma centers and use the existing regions as a base. And this is what the state looks like broken out across the eight regions. So, where we are in the state, you should be able to identify and locate the healthcare preparedness coalition nearest to you, the region. I’m closely associated or the region I work with. Is here in the middle and with the CapRAC, under Wake Medical Center and Human services. So I like to say, I work for Wake Med, but I don’t really have any command responsibilities. I support the five-county region, healthcare infrastructure. We worked very closely with our two partners in Durham, and in Orange County at the, at the coalition level with there, too coalitions as well. And because do Crawley and you and T Rex are both located in wake. County is why we kinda sort of split into a couple different colors, but we required to associate with us at the CapRAC level. And I guess, I didn’t mention that all hospitals in the state, and all DNS agencies are required by law to associate with a, trauma region, and actively coordinate with the coalitions and those regions to improve the overall Pre hospital care and disaster preparedness for the healthcare infrastructure here in the state. So, let’s talk about a little bit what I do for a living here in the healthcare coalition. Will. So, again, our mission here is to provide access to medical care to all residents before, during and after natural and manmade disasters. And it’s our job to help try to facilitate the need, the pharmaceutical physical facility, triage, tracking and transport coordination for patients that, as identified by our partners. So, again, we, we are the side of the world that that deals primarily in the healthcare. These are just a few of our partners that we actively participate with and collaborate with, on increasing the overall healthcare preparedness in our region. As you see, there’s a in their emergency management, healthcare facilities, hospitals, and even a few volunteer groups. So we are open to anybody who is who could potentially touch the, the healthcare preparedness infrastructure, or healthcare infrastructure and supporting those needs during the crisis. So, we were open to to a lot of those organizations. Alright, so let’s talk about sort of how we do what we do and how we utilized volunteers for that purpose. So, the same medical assistant team is a designated state resource each of the RACs or each of the healthcare preparedness coalitions, how they have to team. And when we, when we talk about typing, it’s a FEMA. See, that’s a term of of how large and how capable that team is so type one being the most capable land largest type team out there. So usually you would see a DMAT team at the federal level via type one DMAT team. So are type two SMAT teams are the second largest and most capable entity of this resource out there. Like I said, there’s eight of them across the state. It’s comprised primarily of medical professionals, our medical license professionals, and they have a, they go through a extensive two day training where they learn how to work within the medical support shelter work within a mobile field hospital and as well as the hospital decontamination and their primary mission is to provide that acute care during a medical surge event, or a, in a shelter capacity. Like I said, these guys are, or these individuals are considered state resources. So when they come out, they get a state badge, like, very similar to what the FAST team, and some other volunteer organizations have. And when they are activated, they are. Expected to find the time to be able to deploy for at least seven days. Normally say, seven to fourteen days. The typical mission is seven and the benefit of being part of the team or one. The benefits for a license medical professionals is that they’re deployed on the state mission, their host agency. So, their hospital or EMS agency that they work with if they, if they’re home agency continues to pay them while they’re deployed then their agencies are eligible for financial reimbursement. For their employees time volunteering with our organization so that’s one of the big benefits of our members again. They go through a two full day training. Our trainings are located in Gardner. That’s where we do our training. We require all… This is Sheri. What is the eight hundred for? The eight hundred, right? So each of the teams have a number of designation. So ours is eight hundred and it reaches back to the fact that our hospital was the last level one or level two trauma center to be designated in the state. So, there’s a eight others in the States so we’re at eight hundred or and, like, our partners over at Duke are I think they’re at five hundred. And so there’s one, two, three, four, five, seven, and eight or six, seven and eight across the state and based on when their hospitals were designated as the trauma center. I see, thank you. Yep, and sorry, I’m talking too fast. Feel free to send me the slow down or if there’s a question from previous slides feel free to bring that to my attention. We require all our volunteers to be part of be within the TERMS system for verification, medical licensures and notification purposes. The SMAT training is a state wide training. So, you can take the initial two day training anywhere in the state, and then become associated with any of the team. So you live in the Triad region, and you want to associate you can go through their two day training and then associate with our team. And we do have some members from the Winston Salem area that will come down and volunteer with that even though they have gone to training in a different part of the state and live closer to another region. So, that’s sort of the volunteers decision to make. But we are in TERMS and that’s how we, that’s our primary method for deployment and volunteer verification. Again, the commitment a level four SMAT members in any of our volunteer organizations is all based on our members interest and availability, but for our SMAT members we try and place a higher expectation that if there’s a big state sanctioned mission that’s coming down, sort of like hurricane Florence hurricane Dorian and stuff like that that are volunteers, especially try to find these seven to fourteen days to come out and work and then have an ongoing effort to maintain skills and expectations for deployments. We encourage our volunteers to go through ongoing training every month, or every other month and those topics range on very various items from how to put up a medical tent to how to work within an austere environment when how to provide that care. To individuals, when you are outside of the hospital system, and not used to working with all the benefits and equipment that come with working in a hospital environment. Of course, the benefit that we offer to our volunteers through this program is the training opportunities to get live additional training opportunities and the areas that that you want typically get in the medical progression and then thing with our non medical volunteers as well. We try and train them up so that they can fulfill basic medical roles. So, first aid and stuff like that. But also how to do in short patients during mass casualties. Our members work special events. So are deployed to support other coalition, such as wins over Wayne. And the Carrie point air shows, they’ll go out there for two or three days, live on costs and independence, and provide medical care to a spectators of those events with our events marathon. So you get that opportunity to work across state across the state. Of course, one of the big benefits is, you’d be able to grow your medical and non medical professional networks. So people who are are looking for a job, or once they move into this career, a faster medical response. We provide those opportunities to put you next to the people who are doing the job day to day. And learn from them, so you can advance your own self and then we talked about the, the backfill reimbursement for, for our team members. Any questions about the Mac team I don’t have any checkboxes up. Or, is there anything Sheri, that, you know, if I see it on upon anything we’ve talked about so far I don’t know what else. Okay. So the medical reserve is sort of the second arm of our, our operations and in the coalition again. Most of the coalitions have a component of the medical reserve, a medical reserve corps they also operate differently. But here’s the sort of the bigger picture we were created after the attacks on September eleventh, 2001 a bunch of medical professionals flocked to New York. Pennsylvania, and D. C. just trying to provide medical care to individuals impacted by the, the attacks, and what they found out. And when he arrived in those areas, there was no way for them to be for their credentials to be verified. So that they were in good standing and we’re able to provide the care that they wanted to offer. And this became a secondary disaster in New York specifically following the attacks. President George W, Bush created what we know now is the Citizen Corps program where you got. The community emerges emergency response team on certain teams, and you got Medical Reserve Corps, Senior Corps. A bunch of these other volunteer groups. We’re sort of out there. President Bush asked in 2002 that all Americans donate two years of their lives towards volunteering and that’s specifically there need to be some sort of components to organize the medical, a medical volunteers to be utilized during the types of events. And so, that’s where you get the medical reserve court currently. There’s about nine hundred and ninety seven units of us throughout the United States. So, again, anywhere in this state, you should be able to get, plugged into an through, a healthcare coalition or public health entity. But if you decide to leave North Carolina, you should be able to locate a unit close to you. So, again, very similar to search. Only we focus on the medical infrastructure and components of a disaster. Very similar to our my team. This is sort of the entry level into volunteers them in in a disaster and health care world. We here in our coalition, we offer a three hour orientation again. It’s located in in Gardner. We require them to be in TERMS with a hundred percent profile completion and that allows us to meet federal requirements again for verifying any kind of medical credentials. Let’s see here again, everything we, the medical reserve court does is pure volunteerism so, even if you to plan a state mission, you’re doing it out of the kindness of the heart and the warm fuzzy feelings you get inside your stomach for, for doing good work again. Everything we do is based on interest and availability. So, that’s what I’ve been part of my job doing is trying to find interesting things all the time. So, that people can feel encouraged to come out and volunteer and then we hold seasonal meetings to keep tabs. And make decisions on the pathway forward for our, for our mercies. Again, we provide ongoing training opportunities on various topics, whether it be skill Labs to help increase the basic medical skills of our non medical volunteers again, CPR, first aid stuff like that. We are offering a skills lab coming up in December. That’s gonna talk about how to respond in the first five minutes of a medical emergency, and we’ll be offering the stop the bleed curriculum during that training as well. So, again, providing non medical and medical volunteers opportunities to learn how to use tourniquets and stop massive bleeding during incidents again, we’re gonna put you right in contact in close proximity to people in the medical profession that wish to grow your network or move into this career field, you’ll be next to people who are doing it every day and then and then mercy program here in our in our program hearing cataract. We have various incentive programs in place to try and encourage people to actively volunteer with us. So, the more you volunteer. And engage with our programs, the more chances you have to win prizes or earn that can be used on future deployments and that’s how we started to keep our volunteers engaged throughout the year. So, a big picture. This is how it looks. Federal dollars come from department of health and Human Services to OEMS, and that’s being the state oversight agency coordinates with all the level one level two trauma centers who manage the rack systems where healthcare preparedness falls or healthcare coalitions. All the healthcare coalitions, then manage the various volunteer programs such as and the SMAT teams, and then specifically here in our region, the capital region, we have formed what we call the North Carolina Triangle coalition, because when you put our coalition, Duke’s coalition and UNC’s coalition altogether, we take up about thirty some-odd counties, I think worth of healthcare infrastructure. So the more we all three can be all on the same page, there’s more consistency across the three regions for healthcare preparedness. And us working together there, so we can move into sort of, when a medical support shelter is does, and the role family members can can fill within a so think medical sport filters. There are always going to be located and fixed facilities to the church hospital or school. The facility is always going to have to have bathrooms and shower facilities. We learned after Florence that our, the facilities need to meet regulation requirements. And so, if if there’s a question to that, we have resources in the state that we reach out to and bring. So in Dorian, we got an ADA compliant bathroom trailer to be utilized to help increase our capabilities and capacities in the state medical support shelter. So the facilities have to meet all the same requirements as most general population shelters do, and then some so need and then some is onsite generator or connections to generator again during Hurricane Dorian. We set up the state medical support shelter at C3 Church in Clayton. They had a generator, but it didn’t run all their facilities within the location. So, the state actually contract with the church to build a new transfer switch and increase their capability. So that we could bring in a generator to just plug right in and it would give us back up power through the, to the entire facility. Should we lose power All the coalitions carry resources to be able to immediately set up one of these shelters for up to sixty patients during Hurricane Dorian CapRAC and Triad coalitions partner together to set up a sixty to eighty bed shelter, medical shelter with the surge capacity to a hundred. And twenty, so again, all our stuff is interchangeable. So if one coalition can’t do it on their own, we definitely partner with other coalitions in the state to increase our capacity. Within the shelters we carry on. We carry a full pharmacy capability to meet the medical pharmaceutical needs of the patients that are in there. This includes tube feeding materials and other basic medications. Normally we’ll staff it with to pharmacist as well, a North Carolina Department of Public Safety officers through their prison system. They will use parole officers first. Now, with the leasing off. Security force for our for our shelters and then the, the shelter itself is managed collaboratively, collaborative lead between North Carolina and coalition staff. So they work within that unified command structure. It’s, it’s all EMS’s responsibility, but it’s all our stuff. So, coalition will staff a lot of the medical and general staff positions while we’re going that’s built a lot of the command and staff positions. So again, incident command staff is gonna be broken down between staff and health care coalition staff, for instance, during Hurricane Dorian CapRAC served as the operations section, chief medical branch director while Triad served as the finance and administration section chief. Well, OEMS did incident commander, liaison, public information roles. When we set one of these shelters up we’re bringing in trained staff of thirty plus – that include physicians, physician assistants, . Nurse practitioners, paramedics, nurses, empties and then certified nursing assistants so anything. So we can provide that kinda level of care or assessment to individuals. Who would normally be housed in a long term care facility nursing home, assisted living or reliant on home health care. So these people are coming to us with medical conditions are non medical volunteers we staff as needed, and they’ll fill mainly roles and supporting the overall logistics of the shelter to this coming up medical logistics re, supplying various nursing stations with supplies, tracking resources to helping clean up the facility, a safe environment to helping hand out food feeding patients, or just providing that that camraderie with the patients and family members for ease of mind. So so, during Dorian, there was also the state state coordinated general population shelter. And there was some medical folks that we’re deployed there. What was the, what would was it like a, a quarter of what a medical shelter would’ve seen the staffing or how is that in relative to medical shelter? Right? So the state coordinated shelter that was set up during during, and at the old Sears department store at North gate mall in Durham, that was in my understand, the state’s attempt to develop, or to establish a large scale general population shelter. So, with what we learned from best practices and lessons learned from Hurricane Harvey and, and some of those other storms that impacted Florida and Houston a couple of years ago, was that if you’re going to house, a bunch of people in a general population shelter, like, they did there needs to be a stronger medical component in those shelters so the volunteers and medical professionals that we sent, and that were brought in from Tennessee to staff at the state coordinated shelter, they’re there to provide more of that acute Pre hospital care. So, it slips, trips and falls. Try to meet basic medication needs and coordination it’s those individual medical individuals at the state coordinated shelter there to try and prevent the medical surge of the local healthcare infrastructure. So, if it’s someone just needs a band aid, they should be able to get that in the shelter. And then it’s whatever the expectations of, in this case the state would be for what level of care should be provided at that shelter based on the medical professionals. There, so, if they had a doc and nurse and the capabilities to do stitches or sutures locally, state EMS or local EMS could say, you know, anything that’s doesn’t require any visit should be able. That isn’t acute or immediate should be able to be taken care of the shelter. And then it’s the coalition, and the state’s responsibility by the staffing and the equipment to be able to perform that level of care in that. Does that make sense? Yes, thank you so much. Yeah, so the care that we’re primarily providing a state medical support shelter is more in line with the level of care that you would find in a nursing home, or a long term care facility. These are individuals who need constant care 24 hour care, either through ventilators to feeding. And and and the other I think I have a slide on exactly what we put into a medical support shelter, which I think is right here. So, individuals who are coming to our shelter, who require active monitoring management or intervention. When they come to us, they have to be triaged, like, if they were going to an E. D. before they’re placed into our shelter, and the way they get to our shelter is through an approval process through local or you could go through a local emergency management or to state emergency management for a consultation on that person’s specific medical needs. And then if they are approved to go to the shelter, then the state and local jurisdiction coordinate that transportation, that individual from their home, or from that nursing home to the shelter. And then when the disaster is passed, it is the the responsibility of the state and the local jurisdiction to get that person back home, back to a new facility. And so, the thing, medical support shelters, not someplace where, if you had somebody in a general population shelter and the shelter manager doesn’t think that person belongs there. They can’t just say, go down the street to the medical support shelter. They’ll take care of you. There’s an approval process for that. And these are the examples of individuals who could be approved to be placed into a state, medical support shelter again 24, four, seven, skilled, nursing requirements, hospice, patients, ventilator, tracheotomy wound management. We see that a lot with our bariatric patients. Bedridden. Of course. And individuals who have been evaluated by medical professionals, so if they was somebody in a general population shelter, that FAST team members said this person, you know, it’s not gonna be able to sustain a healthy, manageable life in the shelter. You could bring that attention to the shelter management or emergency management, or OEMS or human services and get them evaluated either through telemedicine or other various resources that the state can leverage to get that person evaluated on whether or not they need to be transferred to a medical support shelter and or to assist you in identifying what would make that person’s ability to stay in a general population shelter more successful and provide them the access that they need. So, I’ll, show you a few pictures of state medical support shelters in the past. This is Hurricane Florence, Cherry Hospital in Goldsboro. This was the decommissioned psychiatric hospital. It was a good idea at the time for what we had again, a harden facility it took, we did lose power there for a little bit. Army Corps of engineers was able to come in and provide a generator to ensure overall power. I don’t think we’ll ever go back here because of the multi story building for the shelter we also put over a hundred people in here about sixty to eighty patients with another sixty to eighty of their family members or primary care givers. But that is a shelter. This is what it looks like in the inside. Each of the patients are provided a wescott. This is a medical A medical bed, if you will, the backends do elevate to allow for that kinda comfort. We can also attach IV poles and guard rails to prevent falling off this. But everyone who comes into the shelters, provided a care kit a pillow blankets. Like, you would find it at normal shelters as well and that’s sort of what the patient living area look like we have privacy screens for people who require privacy, or we think it just would be better for them to be sectioned off. Especially for when using the bathroom and stuff like that, we have bedside commodes and other. Equipment and resources at our disposal to ensure that we are meeting those needs of those patients. That big gray case in the middle of a hallway is what we call Stevenson case. This is a essentially a mobile nursing station. So everything in that case, there is what you would typically find at a nursing station. So they can provide the, that level of care that they that the patient might need other in the area. Medical supplies. When we deployed, we have three or four trailers that we deploy. that carry all of our biomedical equipment. So ventilators, oxygen tanks, tubing telemetry, sort of see it all lined up there on the wall there in Goldsboro and we’re providing again that level of medical care that is needed for each patient as they come in as they’re assessed. That’s what the parking lot looked like at Goldsboro with all our trailers lined up. That’s our mobile disaster field hospital trailer. We primarily use that, because it had all our bunks and beds in there. So, we also did that for staff billeting and again, that’s just another picture. One of our shelter trailers arriving or being offloaded at Goldsboro. Living within the shelter, you know, you’re going to be provided food every day. Patients get three meals. Staff get three meals. Again, you’re in a hardened facility with air and access to food, water, could be MREs, could be catered in. So we tried to turn that facility into a makeshift long term care facility if you will again, it takes thirty plus people to staff that, and that’s medical and non medical broken into shifts in this case. Because this was a decommissioned hospital. They were able to just set up shop in the already established nursing areas, Our volunteers, our staff for this shelter, they live on the same cots that the patients do. I think this was the one in the middle was from a DMAT team that brought their own. But, again, we’re putting everybody on wescotts, but we’re moving away from that to air mattresses. Now. But, again, those are sort of the living conditions and then again, that was the full team when they were getting ready to demobilize the hospital in Florence. So, moving forward and time to hurricane Dorian at C3 Church they designate is going to be and is a designated location for an SMSS. So anytime that the state requires a state medical support shelter to be opened, depending on impacts that are occurring from that incident, the C3 Church will be utilized for that mission. So we’ll be going back there the next time a hurricane or major incident occurs that doesn’t impact Johnston county or the CapRAC region. This is what it looks like inside again, with the privacy screens, as we were able to set up. Each of the patients had a bed care kit to to be comfort to sleep on. And if at all possible, we try and house both the patient, and their primary caregiver, a family member next to each other. So, unless we get filled up, the family member would sleep across from them or next to them in a westcot. And then the bottom picture there sort of, before and after this is their Fellowship hall, there at C3 Church. Bathroom and shower trailers again, like I said, the church did meet ADA compliance, but they didn’t have enough of access for the amount of patients or individuals we were expecting. We were anticipating to have to surge to a over a hundred bed shelter. So, we asked FEMA to bring in their ADA compliant bathroom and a bathroom trailer. And then we had a shower trailer brought in the shower services within the facility I think, met all the requirements that that needed for a SMSS you also realize that during these type operations, a lot of our patients aren’t getting up to go to the shower. We’re providing them sponge baths, and other types of cleaning on a regular basis from bedside. Again, staff sleeping areas, wescots, these are in various rooms within the shelter. This is a little bit more luxurious than Hurricane Florence. The staff had a little bit more space to spread out and within that designated spots. Again staffing, medical, non-medical professionals. These pictures are from some of our EMTs, nurses, docs, physician assistants. Again, it’s coming fully staffed with fully trained medical and non-medical professionals that know the necessary needs to meet the shelter requirements. So, let’s talk about how FAST. Any questions Sheri, or anything I need to touch on that I haven’t? You’ve done a great job with the overview of things. Alright. So, let’s talk about sort of some staff considerations for FAST members. And if you guys get deployed to a medical support shelter. I guess the key points is to understand that the shelters are managed under the authority of OEMS and is under the direction of NCEM so, this isn’t a Red Cross shelter. This isn’t a DSS shelter This isn’t a pop up shelter at a church that that a community thought it’d be good to open up. So, when we have to open one of the shelters is that the direction of emergency management and OEMS. So, with that comes all the rules and responsibilities and regulations that apply to being able to provide that kind of care in that type of facility that the shelter is a medical shelter for individuals requiring medical medical care. So, if we understand the medical community and understanding the level of care and regulations that hospitals and long term care facilities have to meet, we are striving to meet those same requirements within the shelter. So, the, the good example that we like to use is we might not have enough ADA bathrooms for sixty patients. But those patients aren’t getting up to go use an ADA compliant bathroom there, using a bedside commode or a bed and so things for FAST members to consider when, if they come to a shelter is to really assess what are the needs of the patients? Are there needs being met versus. If we have enough access to a certain facility. And I think I talk about this moving in another slide maybe. But one of the things that we would like to stress to staff members, and somehow would like to have you guys consider is when you come to a shelter is to look at it also through the lens of the family members and the staff. Is there enough facilities and access for family members, who might be elderly themselves. Now, they might not require constant medical care, but are their needs being met and do they have access to the needed supplies or resources for them to either continue to provide assistance in caring for their loved ones at the shelter or maintain their own healthy lifestyle within that shelter and that goes with staffing as well. Staff at the shelter again. This is Sheri. Can you, I mean, with a patient actually bring their whole family with them or is it like a one to one caregiver or family member ratio? So, traditionally, and what we’re trying to work away from, is trying to identify the primary caregiver and provide them space in the shelter. During Hurricane Florence, It was entire families at a time where we work what we’ve been working with OEMS and locals is if a SMSS, medical support shelters opened up in a county, or in, in the area that the county then also follow suit and open up a general population shelter. So, if a family, if one person has a patient, and they have ten family members, we’re gonna try and identify a primary care provider or primary caregiver within that family or immediate family member to stay with them. And then have everyone else stay at the shelter. They have if they have the capability, they have full access to come back to the metal support shelter and visit but that would lessen the footprint impact. Those non medical individuals would have on the shelter. Thank you. I like I said, some of these members that come to us, their member might be bedridden and their spouse is just as old. Just not bedridden. So, there needs need to be also accounted for. I think we do a fairly good job at trying to meet those needs but I think that is something that a role that FAST members can help out with to take time to talk to the family members of the patient to ensure that they are their needs are being met and they have to access that they need. All our shelter staff are well trained and in most cases are licensed professionals. So the care that they’re providing is the level that they’ve been trained to, and it’s meeting those, those requirements. Let’s see patients in the shelter have been, specially approved. Like I said, before the people in the shelter had been specifically evaluated by a medical doctor for a physician to be placed in that shelter. And if that individual shows signs and symptoms of something that the shelter cannot handle, the shelter is staffed with a ambulance strike team that can then transport that a patient to a hospital for advanced medical care. So, everyone in there is not just coming off the street. They’ve been approved to be there and then the, the equipment that we bring in leverage in staff and setting one these up, is meant to meet the needs of individuals to, or in, or who require 24-hour access to care of some sort. So again, ventilators, oxygen, bedside commode, bed pans, walkers, wheelchairs we bring all that equipment with us. So one thing to, as a FAST member to go into medical support shelter and say, you know, this bathroom isn’t big enough versus if this person, you know, this person, we think, can do more, can be more mobile. You know, if you had a walker a wheelchair, it might just be something that we haven’t had the time or ability to assess and or equipment. We haven’t pulled out of our trailer yet that you could be helping us identify how someone can be more self sufficient in the in the shelter and we just haven’t had that ability or conversation with that individual yet. And so a little things like that. Yep. This is Sheri again. As you’re going through and talking about this. I’m wondering if there’s the availability of just like, on the short term basis. Say we have a person in a shelter, a general population shelter that might need some oxygen. Is there a chance that we can utilize the oxygen at a medical support shelter? some other equipment, bring the patient there, but take some of the equipment to the general shelter. That is gonna be hard. What one the roles that the coalition can do and what we did during Florence is try and help either that shelter location, or the county responsible for the for that shelter, identify a vendor, or be in touch with the hospital to leverage resources to be delivered to the. General population shelter directly, I don’t think and, I mean, I’ll, I’ll go out on a limb. I don’t see right now a pathway for where we would ever take resources out of this, out of the medical shelter and deploy them long term, short term to support a general population shelter. But if it’s a FAST member sees someone requiring oxygen in a general population shelter. It might be worth it and knowing that and medical support shelter is open. It might be a good conversation to at least start having of, does this person should this person be better served in a medical support shelter and starting that conversation? If they do then you just increase that person’s capacity to survive during this traumatic event. And if they don’t, you know, then we can find other resources or brainstorm other ideas to get them the services that they need. But that is the role that the coalition can try and help fill outside of our support of the medical support shelter. Yeah. Okay. So, potential areas in which FAST can assist in improving the operations. So, I think I talked about some of these already, but identify areas when which caregivers or family members needs to be improved while saying in the shelter. Again, it should be a foregone conclusion that the patient is being well taken care of and we’re gonna do everything we can to support the patient. I think we do a good job at supporting their family member. But if there’s an area in which we could improve on or an area, and which FAST can specifically focus on is, is really evaluating if that caregiver or that family members also needs are being met. Is this what social services needs of the patient so this could be patient registration or patients discharge again? I think this would fall back on a FAST team members already, you know, either day to day job or training capabilities. But again, it in understanding how we get people into the shelter, and then how do we discharge them from the shelter? A lot of that is relying on a lot of social service work. And if FAST team members have that kind of expertise or understanding, it could help make that process go quicker. And allowing that person to get back to normal, normal life. That’s one of the critical components that we’ve identified in the shelter is planning for that discharge as soon as as that person arrives into the shelter. And there was a national report that was put out regarding patients and shelters that went in medical support shelters, or even put into hospitals during the storms, or and then ending up being released to a more restricted setting, which is something that, of course, disability advocacy community wants to avoid at all costs you want the people to go back to facilities or their homes, and at least restricted setting. So if we can use FAST to assist in, making sure. And ensuring that we would love to be able to do that. Right I think another component that I think that would be good at or it could have a benefit at is, you know, verification of equipment at home or verification that where they’re going to be placed is going to meet the needs of that individual. And I know during Florence, or during even hurricane Mathew, when we try to discharge patients back to their homes, their homes were, you know, might not, I mean, we didn’t put anyone in an environment where they shouldn’t have been but if we have the capability of say, hey, if someone can go to this location, you know, with a family member and verify that the location is suitable, for that patients return, then would help cut down like you said, that that the inappropriateness of placing that person in a long term care facility, or at a hospital where they’re not gonna have the same kind of access. They’ll get all the care they need, but their, their, their mobility and independence is gonna be compromised day to day from that situation if you will. Within our shelter system, another gap that we identify as mental health. So, a lot of times we focus on the physical health of not only the patient, or we focused a lot on primarily on the physical health of patients, family members. What we are trying to do better at is also ensuring that we’re meeting the mental health needs of our of our patients and our family members, and that of the staff. So again, a FAST member coming into this type of environment with the sort of and more open mind as to what is needed beyond the physical needs of the patient staff, or or a family member is to have a good understanding. Is that if the mental health is needs and care is being met for the patient that the staff and the family. And so again, another area that I think fast could be a benefit as is either bringing that to the attention shelter management, or be able to provide that kind of service. And I have no idea what’s driving past. So, just give me a second. He’s moving pretty fast and then everything we do safety is the big concern. So, beyond beyond the typical what? I think that the numbers will be looking for in terms of safety. But any other slip, trip hazards for our patient staff or members or anything that is safety, you know, that could cause a concern for safety issues. In terms of fire, fire code, evacuation and shelter in place procedures, stuff like that just ensuring that those things are in place and are helping should a FAST team member find themselves in that type of situation. Hurricane Dorian for example, they had a fire alarm and a tornado warning occur at the exact same time and so, having additional staff there to have eyes on of either identifying if there was a fire occurring and or helping ensure that patients and staff are well sheltered during that tornado warning. It would be a help as well. And then the big, another big thing for fast to consider if they’re deployed to is being that liaison between the shelter and Human Services branch. I don’t know how great the communications is in this regard. Anyway. I think we have a tendency to work in silos and with the being stationed in emergency services, while we are primarily providing a human service during this disaster. If we are able to leverage more human services capabilities and resources, it might help life in the shelter in general improve. But also, like, I said, improve the overall capabilities for bringing people into the shelter who need to be housed in the shelter. But also helping in the discharge of those patients back to their homes, or back to another facility. And something that human services does good is shelter and shelter, operation and shelter coordination. So either passing information or helping be that liaison of, you know, we don’t have this resource, you know, can we leverage human services? And some of our nonprofit partners. This is Sheri again. And I want to clarify that when we’re talking about human services branch I believe you’re talking about the branch in the emergency operations center and state level. Yes, great great. And just to let, you know, and just let other people on the phone know that the FAST coordinator is actually located in human services branch, breakout room. So there is that connection right there and I think you hit the nail on the head. I think it would be a great opportunity for that liaison position, right? Yeah the more we can keep us informed about what’s going on in the shelter world, and the more that we at the field level can keep emergency human services in the loop. I think it’s the bet is, is gonna make the whole process of sheltering general population in medical needs individuals a lot smoother. So, here’s some sort of just some tips. I think to help FAST team members. Lessons, learned that. We’ve seen over the last couple of years. And in the response, and then the growth of this program, and I know the capabilities of the FAST team are increasing by the day, and sure. He’s doing a great work at that. So a lot of these problems are not problems, but areas that we think friction will improve over time. So, when trying to make a first impression at the shelter, because there’s no guarantee that. In the operational briefing, or that word is passed throughout the shelter that you are coming to the shelter to provide a service. Is to ensure that you have the proper credential and and uniform or, you know, taking on that, that personification that you are a fast team member. We’ll go a long way when you get onsite, it’s important to sign in to the shelter ensure that you’re, you’re meeting all the requirements for accountability purposes and then try and make your way to shelter management. There’ll be a lot of people walking around the shelter who are staff, they’re going to want to know who you are, and why you’re there. And you could come across people with very rough personalities. You come across people who are more than jovial and excited that, that you were there but the sooner you can make it to a shelter manager position, and then command staff that with, or in the command post. Your experience in the shelters and be vastly improved, because that information is gonna go out to everybody that you were there and you have a purpose for being there. And and with the expectation of of your role again at the shelter, we provide meals. So, if there’s an expectation that if you were to being deployed to a shelter, ensure that the shelter manager, shelter, management staff, know when to expect you, and if you are going to require a meal or an overnight common accommodation in some instances, they’ll run out of space to accommodate individuals coming in, from the outside world. We ran into this during Hurricane Florence where we were definitely overstaffed to the point where, you know, we did not have any more bed for patients or for staff members. So. It’s important to understand that if there’s an expectation for you to stay overnight, or to be fed, that the costs that the shelter is going to accrue and you’re displacing, maybe a staff member from their bed or not having a bed for you. And there’s enough time those resources can be leveraged to ensure that your accommodation needs are met. But the sooner that information is communicated, the better when you arrive. Like I said, signing the check in desk, speak to the shelter manager. Because there are going to be your conduit to the rest of the staff, the more professional and efficient with whatever tasks you are trying to accomplish on the shelter are going to also be a benefit to you in the shelter. They are very focused on tasks and providing that medical care and they really much do not appreciate anything or anyone that comes in that could jeopardize their battle rhythm if you will. So the more the change, the more efficient you can be with your task and understanding your tasks and role and or knowing not to get in the way of care being provided is going to go a long way as well. And with that professionalism, you’re there representing FAST and Human services. So more professional you can be. And speaking to that level with the staff on site is going to be a benefit. Report any issues findings or thoughts that you have back to the shelter manager, or the command staff. The last thing we want is for any kind of rumors to spread within the shelter environment that way if you’re going up straight to the top, it can work its way down as opposed to bringing a certain issue to the attention of a nurse or logistics person. Again, they might not have a full understanding of what FAST is and what your role is there is, if you can bring it to the upper management or EMS personnel, they can make the, they can make those changes and command decisions from the top down. And then, like I said, the big thing is trying to prevent any kind of medical care that’s being provided to the patients. Sorry that’s always our number one mission is to that care is being provided. This is who I am. This is my contact information and our team leader at the coalition is Janice brown and her contact information. And if you have any other suggestions or ideas or questions, or interests feel free to reach out to us. And and I will sort of end it there. I, I just about made it an hour, Sheri, but I’ll, I’ll open up for questions or I can talk about anything that I might have missed that we had talked about originally. Thank you, Nicholas. Are there any questions at all? Okay, because I’m have to do do you have any questions? typing? if anyone does have any questions, you’re more than welcome to shoot them over to Sheri or like, you know, shoot me an email and I’ll, I’ll respond as I can. So I know there there was a lot of information about a lot of different topics. I I appreciate the opportunity to share this with you guys, thank you so much Nicholas and this will be recorded. This is being recorded. So, people will have the opportunity to access this at a later time as well. So thank you all. And thank you. Nicholas, thank you. Thanks so much. Talk to you guys later.