State of Delaware Department of Health and Social Services Division of Public Health Annex to Emergency Support Function (ESF) 8 MEDICAL NEEDS SHELTER (MNS) PLAN ______________________________________________________________________________ TABLE OF CONTENTS 1.0 Purpose 2.0 Situation and Assumptions 3.0 Concept of Operations 3.1 General 3.2 Oversight and Management 3.3 Patient Capacity 3.4 Operation 3.5 Facilities 3.6 Support Services 3.7 Activation 3.8 Case Definition of Typical MNS Client 3.9 Considerations for MNS Activation 4.0 Participants 5.0 Roles and Responsibilities 6.0 Staffing and Organization 7.0 Decision-Making 8.0 Notifications 9.0 Response 10.0 Communications 11.0 Plan Maintenance 12.0 Training, Exercise and Evaluation 13.0 Tabs TAB A—Patient Classifications TAB B—Glossary TAB C—Facilities TAB D—Resources Tab D-1—Forms Tab D-2—Supplies and Equipment for MNS Tab D-3—Medical Needs Shelter Signs TAB E—Job Action Sheets (JAS) TAB F—Memoranda of Understanding 1.0 Purpose 1.1 The purpose of the Medical Needs Shelter (MNS) is to provide adequate, short-term, supportive medical care during a natural or technological disaster when the patient is displaced from their home or specialized facility and cannot be accommodated at a general population shelter due to their medical needs. 2.0 Situation and Assumptions 2.1 The Governor has declared a State of Emergency. 2.2 An increasing number of people are sustained at home using medical equipment and skilled care for respiratory assistance, feeding, and medications. 2.3 Natural or technological disasters may affect the operation of the specialized medical equipment or the ability to get medical care to the patient. 2.4 Prolonged events may quickly deplete home medical supplies. 2.5 During a mass casualty incident, hospitals and long-term care facilities may not be an appropriate location for the care of this patient sub- set due to available space considerations and the need for beds to be made available to the maximum extent possible. 2.6 The establishment and use of MNS sites should be a last resort after a declared State of Emergency, and hospitals may be able to accommodate potential MNS patients, depending on the circumstances of the event and the judgment of the SHO, State and county EMAs, EMS, and ARC. 2.7 The American Red Cross of the Delmarva Peninsula (ARC DMVP), hereafter referred to as ARC, does not provide medical care within its shelters. 2.8 MNS operations may be expanded within operating MNS sites or to other locations at the discretion of the SHOC. 3.0 Concept of Operations 3.1 General 3.1.1 The MNS is designed to serve as a transitional area, with capability for a short term stay (up to 96 hours), with all patients then being returned to their homes or moved to other long-term care facilities. The shelter staff will provide care under the written guidelines and with medical direction as set forth here. When necessary medical care exceeds written protocols, shelter staff will consult the Medical Director for specific physician orders. 3.2 Oversight and Management 3.2.1 The Division of Public Health (DPH) oversees the MNS in accordance with the Delaware Emergency Operations Plan (DEOP), ESF 8-Public Health and Medical Plan. 3.2.2 The Delaware National Guard (DNG) will provide medical oversight and staffing for MNS operations. 3.2.3 The Delaware Emergency Management Agency (DEMA) will determine appropriateness of MNS activation based on emergency conditions, agency recommendations and resources. 3.3 Patient Capacity 3.3.1 Each MNS is designed to accommodate up to 50 patients. 3.3.2 A MNS can be expanded to accommodate up to 200 patients if necessary with the deployment of four (4) MNS trailers to the same shelter site. 3.4 Operation 3.4.1 The MNS is designed to operate continuously for 96 hours if necessary. 3.5 Facilities 3.5.1 The MNS plan can accommodate opening and staffing of up to four (4) MNS concurrently, depending upon the mission priorities for DNG and the availability of the Delaware Medical Reserve Corps (DMRC). 3.5.2 Primary and back-up facilities should be pre-identified and evaluated in each county and the City of Wilmington to allow for activation to meet specific needs of the situation (see Tab D for Criteria). 3.5.3 DPH, with concurrence from the local emergency management agencies (EMA) will maintain signed agreements with facility owners. 3.6 Support Services 3.6.1 MNS will be either co-located with or in close proximity to American Red Cross (ARC) Shelters. 3.6.2 ARC will provide basic shelter services to all residents including food and sanitation. 3.7 Activation 3.7.1 Before the MNSs can be activated, the Governor must declare a State of Emergency. 3.7.2 Requests to activate MNSs should be made by the local Emergency Management Agencies (EMAs), DPH, ARC, local Advanced Life Support (ALS) services (through local EMAs), hospitals (through DPH) and others to DEMA. 3.7.3 Upon accepting the request(s) to activate one or more MNS, DEMA will designate the MNS sites to be used. (Site list in development) 3.8 Case Definition of Typical MNS Client 3.8.1 A MNS is designed to care for people with minor health or medical needs that may require assistance with activities of daily living (ADL’s), professional observation, maintenance and/or assistance with medical treatments including medication administration or dressing changes. The facility should not be used for individuals requiring extensive medical treatment. They should be referred to a hospital for treatment. 3.8.2 Patients are classified as either Level one (1), two (2), or three (3). Level 2 patients are acceptable for the MNS. (See Tab A for examples). Level 1 patients are sent back to ARC shelters. Level 3 patients are forwarded to area hospitals 3.8.3 Examples of acceptable patients are not all-inclusive and the MNS triage officer with medical direction has the authority to make final admission decisions. 3.8.4 Patients with certain behavioral disorders (except for those that are suicidal, homicidal, or that otherwise present a danger to themselves or others) may be admitted to the MNS at the discretion of the Triage Officer and the MNS Site Director. 3.8.5 Individuals with non-typical functional needs will be allowed into the MNS at the discretion of the MNS Site Director. 3.9 Considerations for MNS Activation 3.9.1 The following is a list of considerations when determining whether to activate a MNS: 3.9.1.1 An evacuation of the public has occurred or may occur, causing persons with medical needs as described in Section 3.8 to seek shelter. 3.9.1.2 Evacuation is expected to last more than eight (8) hours. 3.9.1.3 Hospitals cannot accommodate surge of patients during an emergency. 3.9.1.4 Local emergency medical services are experiencing increased call volumes due to extended travel times and limited hospital choices. 3.9.1.5 A number of people with special medical needs have arrived at the ARC shelter and/or the ARC is receiving requests to shelter people with special medical needs. 3.9.1.6 Depending on the situation, the SHO can determine the need to either open one or more MNS within a given local jurisdiction or to send the potential MNS patients to area hospitals. 4.0 Participants 4.1 Primary Agencies 4.1.1 Division of Public Health (DPH) 4.1.2 Delaware National Guard (DNG) 4.1.3 Counties and Local Emergency Management Agencies (EMA) 4.1.4 Delaware Emergency Management Agency (DEMA) 4.1.5 Delaware State Police (DSP) 4.1.6 Division of Substance Abuse and Mental Health (DSAMH) 4.1.7 Division of Medicaid and Medical Assistance (DMMA) 4.2 Support Agencies 4.2.1 American Red Cross of the Delmarva Peninsula (ARC) 4.2.2 Basic Life Support Agencies (BLS) 4.2.3 Advanced Life Support Agencies (ALS) 4.2.4 Department of Transportation (DelDOT) 4.2.5 Hospitals 4.2.6 Home Health Care Agencies 4.2.7 Hospice Care Providers 4.2.8 Durable Medical Equipment Suppliers 4.2.9 Communications Corps 4.2.10 Local Law Enforcement Agencies 4.3 Other 4.3.1 Patient/Family/Caregiver 5.0 Roles and Responsibilities 5.1 Primary Agencies 5.1.1 Division of Public Health 5.1.1.1 Develops and maintains the Medical Needs Shelter (MNS) plan. 5.1.1.2 Develops, maintains and annually reviews Memorandums of Agreement (MOUs) with 4-8 potential facilities for MNS sites (two in each county and the City of Wilmington). Local EMAs to assist in identification and evaluation of sites. 5.1.1.3 Maintains and updates contact information quarterly. 5.1.1.4 Provides contact information to agencies identified in MNS Plan. 5.1.1.5 Recommends activation of MNS to DEMA upon hospital request or other determination based on impact to health care system. 5.1.1.6 Oversees MNS as described in Sections 1.1 and 3.2.1. 5.1.1.7 May need to provide staff as described in Section 6.0, if DNG is unavailable. 5.1.1.8 Coordinates needs of MNS as requested from the MNS Medical Director. 5.1.1.9 Provides additional medical staff from Medical Reserve Corps as available and needed. 5.1.1.10 Transports staff, supplies and equipment to MNS. 5.1.1.11 Provides adequate supplies and equipment to support a minimum of four (4) MNS concurrently each with 50 patient capacities. Recommended equipment listing and agency responsible is listed in Tab E-2— Supplies and Equipment for MNS. 5.1.1.12 Coordinates with hospitals. 5.1.1.13 Provides public notification of MNS openings and location. Coordinate with DEMA and Joint Information Center (JIC), if activated. 5.1.1.14 Identifies needs and provides training to Delaware National Guard staff. 5.1.1.15 Exercises the MNS plan in cooperation with the support agencies. 5.1.1.16 Develops a MNS Fact Sheet for distribution to the medical needs community. 5.1.1.17 Works with the DPH’s Office of Health and Risk Communications (OHRC) to develop a media awareness campaign. 5.1.1.18 Coordinates the use of Interpreter Corps to meet the needs of those with language barriers and for those who are deaf or hard of hearing. 5.1.1.19 Maintains records and documents agency costs. 5.1.2 Delaware National Guard (DNG) 5.1.2.1 Provides command and control, medical oversight and staffing for MNS operations. 5.1.2.2 Provides primary security personnel to MNS. Security staff should minimize access to the MNS by other persons sheltered at the same location unless they are a family member or caregiver to a patient, as well as restricting non-MNS personnel access to the Administrative, Pharmaceutical, and Counseling areas. DNG security staff may also assist in crowd control. 5.1.2.3 Provides primary staff as described in Section 6.0. 5.1.2.4 Ensures staff is trained in operations. 5.1.2.5 Reports patient count as determined to the State Health Operations Center (SHOC) during an emergency. 5.1.2.6 Assists DPH with maintaining adequate supplies and equipment to support a minimum of four (4) MNSs each with a 50 patient capacity. 5.1.2.7 Transports staff, supplies and equipment to MNS. 5.1.2.8 Provides back-up power sources/fuel as requested. 5.1.2.9 Participates in annual plan review. 5.1.2.10 Participates in annual training and exercises. 5.1.2.11 Maintains records and documents agency costs. 5.1.3 County and Local Emergency Management Agencies (EMA) 5.1.3.1 Identify transportation resources with DEMA to transport patients. 5.1.3.2 Assess local impact prior to disaster to recommend decision to open MNS. 5.1.3.3 Request DEMA to open MNS, in accordance with Section 3.9. 5.1.3.4 Provide logistical support to MNS in their jurisdiction as requested by the SHOC through the ESF-8 liaison at DEMA. 5.1.3.5 Participate in annual plan review. 5.1.3.6 Participate in training and exercises. 5.1.3.7 Maintain records and document agency costs. 5.1.4 Delaware Emergency Management Agency (DEMA) 5.1.4.1 Work with the Governor’s office to declare a State of Emergency. 5.1.4.2 Facilitates overall coordination of statewide emergency. 5.1.4.3 Makes activation/deactivation decisions regarding MNS. 5.1.4.4 Directs DPH, DNG, and ARC to activate MNS. 5.1.4.5 Coordinates with and provides updates to local EMAs. 5.1.4.6 Arranges for transportation of patients 5.1.4.7 Activates the DNG. 5.1.4.8 Tasks state agencies to support ESF 8/MNS operations as necessary. 5.1.4.9 Secures federal support if appropriate. 5.1.4.10 Seeks and disburses funds for reimbursement for MNS operations. 5.1.4.11 Participates in annual plan review. 5.1.4.12 Participates in training and exercises. 5.1.4.13 Maintains records and documents agency costs. 5.1.5 Delaware State Police (DSP) 5.1.5.1 Assists by providing additional security personnel if requested by DNG. 5.1.5.2 Participates in annual plan review. 5.1.5.3 Participates in training and exercises. 5.1.6 Division of Substance Abuse and Mental Health (DSAMH) 5.1.6.1 Plans for and provides mental health support for MNS. 5.1.6.2 Participates in annual plan review. 5.1.6.3 Participates in training and exercises. 5.1.7 Division of Medicaid and Medical Assistance (DMMA) 5.1.7.1 Conduct case management and assist with client discharge upon closure of MNS. 5.1.7.2 Participates in annual plan review. 5.1.7.3 Participates in training and exercises. 5.2 Support Agencies 5.2.1 American Red Cross of the Delmarva Peninsula (ARC) 5.2.1.1 Provides administrative oversight to the ARC shelter, if co-located with MNS. 5.2.1.2 Ensures that all center occupants (evacuees and staff) are registered upon arrival and are provided orientation information. 5.2.1.3 Maintains a system for checking occupants in and out when they leave the shelter for any period of time. 5.2.1.4 Provides information services for shelter residents. 5.2.1.5 Acts as primary advisor to shelter manager on all administrative, registration and patient tracking matters. 5.2.1.6 Provides food service for staff and patients. 5.2.1.7 Shelters healthy family members and caregivers of patients. 5.2.1.8 Recommends activation of MNS to DEMA when normal shelter operations are receiving influx of patients not suitable for ARC shelter. 5.2.1.9 Participates in annual plan review. 5.2.1.10 Serves as primary agency in conjunction with DEMA for ESF 6 Mass Care and maintains complimentary Annex to ESF 6. 5.2.1.11 Participates in final facility walkthrough. 5.2.1.12 Participates in annual training and exercise. 5.2.1.13 Maintains records and documents agency costs. 5.2.2 Basic Life Support Agencies (BLS) 5.2.2.1 Provide transportation for MNS patients that either do not have caretakers or that cannot otherwise provide their own transportation. 5.2.3 Advanced Life Support Agencies (ALS) 5.2.3.1 Provide certified paramedic for each location to assist with facilitation of patient transport and resource logistics, if available. 5.2.3.2 Coordinate with local EMAs. 5.2.3.3 Recommend to local EMAs to request MNS through DEMA, if appropriate. 5.2.3.4 Participate in annual plan review. 5.2.3.5 Participate in training and exercises. 5.2.3.6 Maintain records and document agency costs. 5.2.4 Department of Transportation (DelDOT) 5.2.4.1 Serves as transportation back-up to local EMS, as directed by DEMA. 5.2.4.2 Provides access control support to the MNS site. 5.2.4.3 Participates in training and exercises. 5.2.4.4 Maintains records and document agency costs. 5.2.5 Hospitals 5.2.5.1 Provide recommendation, if appropriate, to DPH for potential or actual need for MNS. 5.2.5.2 Provide assistance in locating specialized medical supplies, equipment, medicines, or nourishment to support the MNS, if needed. 5.2.5.3 Participate in annual plan review. 5.2.5.4 Participate in training and exercises. 5.2.5.5 Maintain records and document agency costs. 5.2.6 Home Health Care Agencies 5.2.6.1 Develops and maintains emergency plans for patient care. 5.2.6.2 Cares for their patients during emergencies to the greatest extent possible. 5.2.6.3 The agency personnel should bring essential needs of the patient to assist them with care. 5.2.7 Hospice Care Providers 5.2.7.1 Develops and maintains emergency plans for patient care. 5.2.7.2 Cares for their patients during emergencies to the greatest extent possible. 5.2.7.3 The agency personnel should bring essential needs of the patient to assist them with care. 5.2.8 Durable Medical Equipment Suppliers 5.2.8.1 Service medical equipment whenever possible. 5.2.8.2 Provide medical equipment whenever possible. 5.2.9 Communications Corps 5.2.9.1 Provides back up radio communications support, if necessary, between SHOC Operations and the MNS Medical Director. 5.2.9.2 Maintains records and documents agency costs. 5.2.9.3 Participate in training and exercises. 5.2.10 Local Law Enforcement Agencies 5.2.10.1 Assists by providing additional security personnel if requested by DNG. 5.3 Other 5.3.1 Patients/Family/Caregiver 5.3.1.1 In the event a patient is relocated to an MNS, bring the following items with the patient: * All medications and supplies such as dressings and any other items necessary to the medical care of the patient. * Any durable medical equipment such as wheelchairs, walkers, canes, IV pumps, ventilators, and oxygen tanks. * Personal items such as blanket, pillows, stuffed animals, eyeglasses, diapers, formula, and clothing. * Any special dietary foods. * Mark all items with patient’s name. 5.3.1.2 Upon evacuation of the home, check or attend to the following: * Check to see that all individuals have evacuated the home. * Home secured. * Utilities turned off (only if advised by emergency officials). 6.0 Staffing and Organization 6.1 Command and Control 6.1.1 DNG will establish command and control staff at their operations center to direct the activities of one or more MNS. 6.1.2 Command Staff guidelines for 12-hour shift. Staff Role Agency Number MNS Director (Physician) DNG 1 MNS Logistics Officer DNG 1 Administrative Officer DNG 1 6.2 MNS Staffing 6.2.1 DNG will provide primary staffing. If necessary, Medical Reserve Corps (MRC) members or, if available, DHSS nursing staff, will provide additional, secondary staffing. 6.2.2 The patient-nursing care tech ratio will be approximately 10-1 and be no more than 20-1. 6.2.3 The number and types of medically trained staff are based on 12-hour shifts and care for 50 patients. See staffing chart below for guidelines. Staff Role Agency Number MNS Site Director DNG 1 Administrative Support DNG 1 Triage Officer (Registered Nurse) DNG 1 Registered Nurse DNG 3 Patient Care Technician (LPN, EMT-B) DNG 5 Respiratory Therapist DNG 1 Paramedic (if available) Local ALS 1 Mental Health Professional DSAMH 2 Security Personnel DSP or DNG 1/2 7.0 Decision-Making 7.1 DEMA makes the decision to open one or more MNS. 7.2 DEMA considers the recommendation by DPH based on impact to healthcare system. 7.3 DEMA also considers any requests from local EMAs, ARC and others. 8.0 Notifications 8.1 Upon determination of the need for MNS, DEMA conducts a bridge conference call with the Governor’s Office, DPH, DNG, ARC, and local EMAs to decide to activate one or more MNS. 8.2 DPH, DNG, ARC and local EMAs activate their respective staff to coordinate MNS(s) establishments. 8.3 Local EMAs request the local ALS agencies to deploy paramedic to shelter site, if available. Local EMS may need to transport patients to MNS. If EMS is unavailable, the local EMA will request DEMA to provide transportation support from DelDOT or DNG. . 8.4 DPH, in conjunction with DEMA and the JIC (if established), informs public of activation, conditions and locations. 8.5 DPH keeps DEMA informed of MNS operation. 8.6 DPH keeps hospitals informed of MNS operations. 9.0 Response 9.1 Initial Actions 7.1 9.2 Triage 9.2.1 Patients may arrive by self-report, referral by hospital, another shelter, or local EMS. 9.2.2 The local EMS provider must inform the patient’s caregiver that any patient specific supplies, medications or nourishment must be brought to the MNS by the caregiver. 9.2.3 The Triage Officer triages patients upon arrival at the MNS. 9.2.4 Patient disposition includes: 9.2.4.1 Admission to the MNS. 9.2.4.2 Admission to the ARC shelter. 9.2.4.3 Transport to the hospital. 9.3 Operations 9.3.1 Command and Control 9.3.1.1 The MNS Medical Director is responsible for directing the deployment, set-up, and patient care for all MNS opened under this plan. 9.3.1.2 If there is only one (1) MNS operating, the MNS Medical Director remains on site. If there is more than one MNS operating, the MNS Medical Director directs MNS activities from the SHOC 9.3.2 Communications 9.3.2.1 The MNS Site Director communicates shelter status and requests for needs to the MNS Medical Director. 9.3.2.2 The MNS Medical Director communicates shelter status and requests for DPH support to the SHOC. 9.3.3 Registration 9.3.3.1 ARC shelter registration staff will register patients triaged to the MNS and directed to the MNS. In the event of a large-scale or statewide emergency, however, DPH and/or DNG will undertake registration duties. 9.3.3.2 An MNS patient care record is created for each patient. 9.3.3.3 Upon arrival, patients must complete appropriate forms (MNS Medical Form 2 and first page of MNS Medical Form 3). Patients area also to be fitted with a wristband with their name, Social Security Number, and shelter site written on it. 9.3.4 Caregivers/Family Members/Pets 9.3.4.1 Caregivers/family members should accompany patients to the MNS wherever possible. 9.3.4.2 Each patient is limited to one adult caregiver/family member while at the MNS. 9.3.4.3 The Triage Officer gives each caregiver/family member a wristband with their name written on it for identification. 9.3.4.4 Any minors accompanying a patient may stay at the MNS at the discretion of the MNS Site Director. 9.3.4.5 Caregivers are expected to assist MNS staff in providing care to the caregiver’s patient. 9.3.4.6 Whenever possible, sheltered persons may be called upon to volunteer to assist with other shelter duties as appropriate and approved by MNS Site Director. 9.3.4.7 The ARC registration staff members are to ensure that space is provided in the shelter for the caregiver(s) of the patient admitted to the MNS. If the general population shelter is not co-located within the same facility as the MNS, the MNS Site Director, at their discretion, arranges for the transportation of caregivers/family members between the general population shelter and the MNS and/or for sleeping arrangements at the facility in which the MNS is located, if available. 9.3.4.8 Only service animals are allowed in the shelter. 9.3.5 Level of Care 9.3.5.1 Care provided within the MNS is supportive in nature. Invasive procedures beyond the changing of an IV or suctioning of an airway should not be performed in the MNS unless the situation is life threatening. 9.3.5.2 General patient care ratios are one patient care technician to every 10 patients and no more than 20 patients to one nurse 9.3.5.3 In the case of life-threatening emergencies within the MNS, local EMS should be notified through 911. 9.3.6 Infection Control 9.3.6.1 The MNS staff members are to take appropriate infection control precautions. 9.3.6.2 Special patient precautions are to be noted at the patient’s bedside. 9.3.6.3 Universal precautions are to be followed at all times per policy and procedure. 9.3.6.4 All staff members are to be trained in the proper handling of patients and supplies. 9.3.7 Security 9.3.7.1 DSP oversees security operations as the lead state agency or ESF 1 representative. 9.3.7.2 DNG provides primary security personnel to maintain a secure shelter and assist in crowd control. 9.3.7.3 DSP and/or local law enforcement agencies may assist by providing additional security personnel if requested by DNG. 9.3.7.4 MNS staff members are to wear identification badges at all times displaying name, role, and agency. 9.3.7.5 MNS staff should minimize access to the MNS by other persons sheltered at the same location unless they are a family member or caregiver to a patient. 9.3.7.6 All rooms that contain sensitive equipment (such as computers or records) and pharmaceutical supplies should remain locked during shelter operations. 9.3.8 Patient Counseling 9.3.8.1 A location at the MNS site is to be established from the main patient area for patients who have difficulty coping with the situation. This can also be used to treat staff 9.3.8.2 Mental health professionals from the Division of Substance Abuse and Mental Health are available to provide counseling. They will be visible in all areas of the MNS. 9.3.8.3 Mental health professionals are to float in the main Patient Area to intervene with potential mental health issues. 9.3.8.4 Mental health professionals are to be trained in critical incident stress management and assigned to assist in stress defusing and debriefing, as necessary 9.3.9 Pharmacy Area 9.3.9.1 The MNS Site Director designates a Pharmacy Area located away from the main Patient Area for the storage of patient medication and other supplies. Whenever possible, a nurse’s office with a lockable door and a refrigerator is to be used. 9.3.9.2 The Pharmacy Area will be blocked off, and MNS staff members are to remain vigilant to prevent patient access to the Pharmacy Area. Security personnel should be assigned to the Pharmacy Area to provide additional security. 9.4 Logistics 9.4.1 MNS supplies and equipment are stocked by the DNG and DPH to support MNS operations. 9.4.2 Local hospitals may be called upon for assistance in locating specialized medical supplies and personnel equipment, medicines or nourishment support of the MNS. 9.4.3 SHOC Operations orders medical oxygen to be delivered to the MNS site. 9.4.4 The DNG Logistics Officer is initially deployed to the MNS for set-up and to receive patients. 9.4.5 Logistics staff track all supplies and equipment utilized from DPH, DNG or other resources on appropriate forms. 9.4.6 SHOC Operations may be contacted to support special requests. 9.4.7 ARC may provide food services for staff and patients without restricted diets, in the event ARC is unable to meet demand, such needs are to be coordinated through the State EOC to ESFs 6 and 11. 9.4.8 The MNS administrative staff members retain all requisitions, supply lists, purchase orders and receipts. All information is to be forwarded to the Military Support Officer (MSO) for cost recovery processes. 9.5 Deactivation 9.5.1 The MNS Medical Director, in consultation with SHOC and the DNG, makes the determination to terminate MNS operations. 9.5.2 SHOC recommends deactivation to DEMA. 9.5.3 DEMA informs ARC, Local EMAs and other state agencies. 9.5.4 SHOC and JIC (if activated) informs public if necessary. 9.5.5 All unexpended supplies and equipment are returned to their source. 9.5.6 Patients are released to their respective family member or caregiver. 9.5.7 Copies of patient care records are fowarded to the caregiver upon written request. 9.5.8 DNG forwards all patient care records to DPH for retention. 9.5.9 The MNS Site Director, the SHOC Site Support Unit Leader or a DPH representative, an ARC representative, and a facility representative conduct a walk-through of the facility. 9.5.10 The MNS Site Director completes a damage report as necessary and provide copy to SHOC. SHOC will maintain copy and send copy to DEMA. 9.5.11 Restoration of the facility to pre-event status is the responsibility of DPH and DNG. 9.5.12 Reimbursement for damages to facility is to be addressed in individual facility MOUs with DPH. 10.0 Communications 10.1 DNG utilizes its regular protocols for communications between the MNS Medical Director and the MNS Site Director. 10.2 Primary methods of communications between SHOC Operations and the MNS Medical Director are 800 MHz radio, telephone, and email in that order. 10.2.1 Communications Corps provide back-up radio communications (ham radios) as specified in ESF 6 – Mass Care Plan. 11.0 Plan Maintenance 11.1 DPH maintains this plan as part of ESF 8 plans and procedures. 11.2 All agencies identified are to review the plan annually. 11.3 Changes in plan and contact information is to be provided to DPH. 12.0 Training, Exercise and Evaluation 12.1 DPH identifies training needs with other agencies participating in MNS operations. 12.2 DPH arranges for training and/or exercise on annual basis. 12.3 DPH conducts critiques of actual event or exercise to determine and correct, if possible, program deficiencies. 13.0 Tabs 13.1 Tab A—Examples of Acceptable Patients 13.2 Tab B—Glossary 13.3 Tab C—Facilities 13.4 Tab D—Resources 13.4.1 Tab D-1—Forms 13.4.2 Tab D-2—Supplies and Equipment for MNS 13.4.3 Tab D-3—Medical Needs Shelter Signs 13.5 Tab E—Job Action Sheets (JAS) 13.6 Tab F—Memorandum of Understanding TAB A—Patient Classifications Level Examples Level 1- Patient needs are able to be met through an American Red Cross Shelter (ARC). * Controlled Insulin-Dependent Diabetic * Ostomies-self care * Foley catheters-self care Level 2- Patient needs are able to be met through a Medical Needs Shelter (MNS). * Stable oxygen-dependent; including those who use an in-home ventilator or Continuous Positive Airway Pressure (CPAP) * Continuous or Intermittent Intravenous (IV) therapy for hydration, antibiotics, pain control and/or other medications * Percutaneous Endogastric (PEG) and Nasogastric (NG) feeding tubes * Apnea Monitoring * Restricted mobility; including those who may need assistance with a wheel chair * Wounds that may require assistance with dressing changes * Assistance with the administration of medications * Hospice * Morbidly obese with assistance needed Level 3- Patient needs are only able to be met at a hospital or other institution. * Significant behavioral health issues * Unstable cardiac * Bed-ridden with extensive medical needs * On life-sustaining treatment * Newly placed central lines, NG or tracheotomy tubes * Contagious conditions that require special precautions TAB B—Glossary A ALS Advanced Life Support ARC American Red Cross of the Delmarva Peninsula B BLS Basic Life Support C CPAP Continuous Positive Airway Pressure D DelDOT Department of Transportation DEMA Delaware Emergency Management Agency DEOP Delaware Emergency Operations Plan DMRC Delaware Medical Reserve Corps DNG Delaware National Guard DPH Division of Public Health E EMA Emergency Management Agency for local jurisdictions including the City of Wilmington, New Castle, Kent and Sussex Counties EMS Emergency Medical Services EMT-B Emergency Medical Technician Basic EOC Emergency Operations Center ESF Emergency Support Function F G H I J JAS Job Action Sheets JIC Joint Information Center K L LPN Licensed Practical Nurse M MARS Military Affiliated Radio System MNS Medical Needs Shelter MOU Memorandum of Understanding MRC Medical Reserve Corps MSO Military Support Officer (DNG) N NG Nasogastric O P PEG Percutaneous Endogastric Q R S SHO State Health Officer SHOC State Health Operations Center T U V W X Y Z TAB C—Facilities 1.0 Selection Criteria The following is ideal criteria for identifying facilities to serve as MNS. Circumstances may prevent adherence to criteria due to public need. MNS may be identified on an ad hoc basis should the primary and back-up MNS become unavailable. 1.1 Availability of back-up power for wall outlets in area identified for patient care or be “generator-ready” with appropriate rapid hook-up connection in-place. 1.2 Located outside the zone or path of hazard. 1.3 Structurally sound to sustain the event. 1.4 In compliance with American Red Cross shelter criteria standards. 1.5 Ramp(s) with walk-way overhang and over-size doors to support over- sized equipment and supply delivery and to serve a dual role of emergency transport exit. 1.6 Americans with Disabilities Act Accessibility (ADA ’92). 2.0 Pre-Selected Facilities 2.1 A primary and back-up facility will be located in each county and the City of Wilmington. 2.2 A listing of primary and alternate shelter locations will be maintained under a separate cover. 3.0 MNS Set-up 3.1 The MNS will be generally set-up in one to two large rooms adjacent to, but separate from, the ARC sheltering areas. 3.2 The maximum capacity of the MNS is 50 patients. This number may fluctuate down depending on facility size. The actual bed capacity of the MNS is at the discretion of the MNS Site Director and is dependent on size of the facility, anticipated number of patients, and available staff. 3.3 The beds should be set-up with a minimum of three (3) feet between beds. A chair should be placed between each bed. 3.4 Men should be separated from women by partitions or other physical barriers if feasible and appropriate (e.g. there are no serious injuries involved). 3.5 A designated area should be established for pediatric patients and their family/caregiver. 3.6 Access to the MNS should be limited to the greatest extent possible. 3.7 A staff rest area should be established in a quiet area of the shelter. 3.8 Food service for the MNS is provided through the ARC shelter. 3.9 The MNS staff will notify the ARC food service staff of food requirements for MNS patients. 3.10 The ARC is not expected to supply specialized dietary foods for MNS patients. 3.11 The MNS Site Director will note any specific facility damage prior to set-up of the MNS area(s). TAB D—Resources Tab D-1—Forms MNS FORM 1 Medical Needs Shelter Rules MEDICAL NEEDS SHELTER RULES 1. Staff, volunteers, and visitors must sign in at the front desk. 2. No firearms, drugs, or alcohol are allowed in this facility. 3. No pets except for service pets are allowed. 4. No Smoking allowed. 5. You must use the public pay phones. Office phones are for emergency staff communications. 6. Meals will be served at: a. Breakfast:_____________________________________________ b. Lunch:________________________________________________ c. Dinner:________________________________________________ 7. Quiet Hours are _____________________to__________________. 8. Please help keep your area and the facility clean. 9. Please secure your valuables. Shelter staff is not responsible for lost items. 10. If you have any questions or problems, please ask one of the staff members for assistance. (Please post) MNS FORM 1 MNS FORM 2 Medical Needs Shelter Registration Record MEDICAL NEEDS SHELTER REGISTRATION RECORD TO BE COMPLETED BY PATIENT MNS FORM 3 Medical Needs Shelter Triage Sheet MEDICAL NEEDS SHELTER INITIAL TRIAGE SHEET TO BE COMPLETED BY PATIENT MEDICAL NEEDS SHELTER INITIAL TRIAGE SHEET MNS FORM 4 Medical Needs Shelter Medical Update MEDICAL NEEDS SHELTER MEDICAL UPDATE A signature must accompany all entries. Date/Time Observations/Notes Use Progress Notes sheet for additional info Medications/Treatments Given Signature/Title MNS FORM 5 Medical Needs Shelter Progress Notes MEDICAL NEEDS SHELTER PROGRESS NOTES MNS FORM 6 Medical Needs Shelter Patient Log MEDICAL NEEDS SHELTER PATIENT LOG Patient Name Date of Birth Location Prior to Admission Please specify address or facility name. Arrival Date & Time Discharge Date & Time Discharge To MNS FORM 7 Medical Needs Shelter Daily Staff Sign-In Sheet MEDICAL NEEDS SHELTER DAILY STAFF SIGN-IN SHEET DATE____/____/____ Name Day Shift Title Time Total Hours Name Night Shift Title Time Total Hours In Out In Out MNS FORM 8 Medical Needs Shelter Visitor Log MEDICAL NEEDS SHELTER VISITOR LOG Name Person Visiting Date Time In Time Out MNS Form 9 Medical Needs Shelter Pharmacy Inventory Medical Needs Shelter Pharmacy Inventory Patient Name Medication/Equipment Notes/Comments (Dosage, Special Instructions, etc.) Tab D-2—Supplies and Equipment for MNS Door Lock Key #2759 Administrative & Office Equipment UOM QTY Trailer Location DE5-271 2 - 3 Hole Punch Each 2 Cart 1/BX A L9815-4 Batteries (AA Size) - Rayovac 8/pk Pack 4 Cart 1/BX A L9814-2 Batteries (C Size) - Rayovac 2/pk Each 4 Cart 1/BX A L9813-2 Batteries (D Size) - Rayovac 2/pk Each 3 Cart 1/BX A DE5-298 Binder Clips, Large 12/Box 3 Cart 1/BX A DE5-295 Binder Clips, Medium 12/Box 3 Cart 1/BX A DE5-297 Binder Clips, Small 12/Box 3 Cart 1/BX A F7SN-8512 Clipboards, Metal Box Each 30 Cart 1/ Shelf 1 K40M99503 Desk/Table Lamp Each 5 Cart 1/ Shelf 2 K441028 Desk/Table Lamp Replacement Bulbs (60 Watts) 4/pk PK 10 Cart 1/BX B DE5-308 Easal and Dry Erase board, Each 5 Trailer Floor DE5-923 Flashlight Each 3 Cart 1/BX A DE5-623 Highlighters (Fluorescent Pink) PK 3 Cart 1/BX A DE5-622 Highlighters (Fluorescent Yellow) PK 3 Cart 1/BX C (de5-053) Labels BX Each 2 Cart 1/BX C (de5-070) Labelwriter 310 label printer Each 1 Cart 1/BX C DE5-648 Marker, Dry Eraser (Black) Each 2 Cart 1/BX C DE5-649 Marker, Dry Eraser (Red) Each 2 Cart 1/BX C DE5-594 Marker, Flip Chart (Black) SET 2 Cart 1/BX A DE5-644 Marker, Flip Chart (Red) Each 2 Cart 1/BX A DE5-097 Masking tape (1" x 60 YD) Each 5 Cart 1/BX B DE5-752 Pad, Lined (Legal) Dozen 2 Cart 1/BX B DE5-739 Pads, Easel 2 Pads Ctn. 5 ctn Cart 1/ Top DE5-760 Pads, Telephone Message (2 part) 100 pgs Book 3 Cart 1/BX C DE5-288 Paper Clamps (Butterfly Shaped) 12 per Box 3 Cart 1/BX C DE5-301 Paper Clips (Jumbo) Box 3 Cart 1/BX C DE5-302 Paper Clips (No. 1) Box 3 Cart 1/BX C DE5-679 Paper, Copy Carton 3 Cart 1/BX D DE5-567 Pen, Stick Ballpoint (Medium Point) Dozen 3 Cart 1/BX B DE5-657 Pencil Sharpener, Electric Each 1 Cart 1/BX B DE5-670 Pencils, Woodcase #2 Dozen 3 Cart 1/BX D DE5-025 Removable Notes (4" x 6") Dozen 3 Cart 1/BX C DE5-277 Scissors Blunt 2 pair Cart 1/BX C DE5-263 Staple Remover Each 2 Cart 1/BX B DE5-258 Stapler Each 4 Cart 1/BX B DE5-256 Staples 5000/Box 2 Cart 1/BX B DE5-110 TAPE DISPENSER Each Cart 1/BX B de5-095 Transparent tape 3/4 in. Roll 4 Cart 1/BX C Envelopes, #10 Business 500/Box 1 Cart 1/BX D Envelopes, 32# Kraft Clasped (9" x 12") 500/CTN 1 Cart 1/ Shelf 3 Labels (allergy) Cart 1/ Shelf 2 Housekeeping Equipment Locking Medicine Cabinet (Safe) Each 1 Cart 1/ Shelf 3 dia 12190-71 Body Lotion 288/case Case 1 Cart 2/ Shelf 2 01831-1 Chlorine bleach, liquid 4 gal/ Case 1 03217 Disinfectant Spray (Franklin) 12/Case Case 1 Cart 1/ Shelf 3 goj9659 Hand sanitizer 12/case Bottle 1 Cart 1/ Shelf 3 03301 Paper Cups, 8 oz. 1000/per case 1 Trailer Floor 27787-1 Paper Towels 12 rolls Case 1 Cart 1/ Shelf 3 28854 Sandwich Bags 10 x 14, 1000 Case 1 Cart 1/ Shelf 3 28885 Facial Tissue, 200/40 packs Case 1 Cart 1/ Shelf 4 Medical Equipment and Supplies Antipruritic ointment ? Tube 1 Cart 3/BX E Bag-Valve-Mask, Adult ? 6/Case Case 1 Cart 3/BX E Bag-Valve-Mask, Child ? Each 3 Cart 3/BX E Bag-Valve-Mask, Infant ? Each 3 Cart 3/BX E Carts for Trailer Exam gloves, Extra Large (11", .6 mil Nitrile) 50/Box Box 2 Cart 2/BX B Exam gloves, Large (11", .6 mil Nitrile) 50/Box Box 2 Cart 2/BX B Exam gloves, Medium (11", .6 mil Nitrile) 50/Box Box 2 Cart 2/BX B Exam gloves, Small (11", .6 mil Nitrile) 50/Box Box 2 Cart 2/BX B Sharps Containers (2 gallon) 20/box Each 20 Cart 2/ Shelf 1 99401-000618 AED Each 1 Cart 1/ Shelf 4 99401-000618 AED replacement Defibrillator Pads (6/box) Each 4 Cart 1/BX E 17521 1" x 10 yds 12/Box 2 Cart 3/BX C 17520 1/2" x 10 yds 24/Box 1 Cart 3/BX H 17522 2" x 10 yds 6/ Box 4 Cart 3/BX C 59357 Acetaminophen (non-aspirin) - Liquid,pediatric Pediatric 1 Cart 3/BX A 64100 Acetaminophen (non-asprin) Adult Each 1 Cart 3/BX C 72095 Adhesive strips Ass. Size 60/Box 1 Cart 3/BX C 50925 Adhesive tape 3" x 5" 4rl/bx 2 Cart 3/BX C 68534 Alcohol Prep 3000 Case 1 Cart 4/BX A 68902 Alcohol, isopropyl 1 pint 1 Cart 3/BX C 10104 Ammonia Inhalant - Breakable Capsules 100/Box Box 1 Cart 3/BX D 63031 Antacid, low sodium - Alcalak - 50 x 2 100 Box 1 Cart 3/BX A 75249 Antibiotic ointment - Neosporin ointment 1 oz Tube 1 Cart 3/BX C 74125 Antiseptic Bottle 16 oz bot 1 Cart 3/BX E 08627 Applicator, cotton-tipped - Case of 2000 6” long Case 1 Cart 2/ Shelf 2 63013 Aspirin, 5 grain - Tri-Buffered aspirin 250 pkgs 1 Cart 3/BX A 55503 Bandage gauze roller 12/bag Bag 1 Cart 3/BX B 58266 Bandage, Self-Adhering, 3" x 5 yds. - 24/Box Box 2 Cart 3/ Shelf 3 Asst. Colors 41749 Bandage, Self-Adhering, 6" x 4.1 yds. 16/Box Box 1 Cart 3/BX G (Non-Sterile) 68182 Band-Aids, (3/4" x 3") 100/Box Box 1 Cart 3/BX C 50703 Basin, 8 Qts, Disposable Each 50 Cart 2/ Shelf 4 12586 Bed Pan, disposable Each 50 Trailer Floor 75646 Bedside Commode w/ comfort grip armrest Each 2 Cart 4/ Shelf 3 01864 Betadine scrub solution - 16oz Bottle 12 Cart 3/ Shelf 3 55445 Bio-Hazard Infectious Waste Bags, 10 Gallons 50/Box Box 3 Cart 4/BX C 36058 Bio-Hazard Waste Container 20 gal Each 2 Cart 4/ Top 46303 BP Kit (Adult, Child, Infant, Obese, Thigh) Each 2 Cart 4/ Shelf 2 Blue - Kits 53731 Bulb Syringe, 2oz. Each 5 Cart 3/BX F 58150 Calamine lotion 4oz Bottle 1 Cart 3/BX B 72063 Central Line Kit (Dressing Tray/ w/Tegaderm Each 2 Cart 3/BX G 65886 Compact Suction Unit Each 1 Cart 4/ Shelf 1 66124 Compact Suction Unit Each 1 Cart 4/BX B 66125 Compact Suction Unit Each 1 Cart 4/BX B 74250 Compact Suction Unit Pkg of 6 2 Cart 4/BX B 66126 Compact Suction Unit - 800cc Each 1 Cart 4/BX B 45873 Compressor/ Nebulizer (Pulmo-Aide) Each 2 Cart 4/BX B 17434 Cotton balls - non sterile, large 2000/ Case 1 Cart 3/ Shelf 4 43067 Dressing, 2 x 2 (10/Box) 10/per Box 5 Cart 3/BX A 43069 Dressing, 4 x 4 (10/Box) 10/per Box 5 Cart 4/BX A 08881 Elastic bandage 10/Box 3” 2 Cart 3/BX C 11707 Emesis Basin, Disposable Kidney Shaped 10/ctn Ctn 5 Cart 4/BX C 66033 Epipen auto injector Pkg of 2 1 Cart 3/BX D 08266 Eye pads 50/Box Box 1 Cart 3/BX G 12277 Gauze Compresses,Ind Wrapped 3X3 or 4X4 200/pkg Each 12 Cart 3/BX H 68813 Glucometer (Accu-Check) Each 2 Cart 3/BX A 76777 Glucometer Strips (Accu-Check) 50/Box Box 2 Cart 3/BX A 68814 Active controls (Accu-Check) 2/Box Box 2 Cart 3/BX A 66951 Lancets (Accu-Check) 100 Box 2 Cart 3/BX A 68542 Handi-Wipes - Bacterial BZK Wipes 100 sheets Box 1 Cart 3/BX C 68903 Hydrogen Peroxide (16 oz. Bottle) 16 OZ Each 1 Cart 3/BX C 11691 Ice Bag 10/Ctn Ctn 1 Cart 3/BX B 58965 Insulin Needle & syringe - 28g x 1/2" 1cc Box/100 1 Cart 3/ Shelf 1 53823 Iodine Swabs 100/Box Box 1 Cart 4/BX A 76140 Irrigation Kit Each 1 Cart 3/BX G 65938 IV Administration Sets, Standard (10 drops) 50/Case Case 1 Cart 3/ Shelf 1 65939 IV Administration Sets, Standard (60 drops) 50/Case Case 1 Cart 3/ Shelf 2 47788 IV Armboard (2" x 9") 6/Pack Pack 1 Cart 3/BX B 41113 IV Poles - 2 hook, caster 1 Each 2 Cart 2/ Shelf 2 63198 IV Preparation Kit - (IV Start Kit)- Each 2 Cart 3/BX G w/ tegaderm dressing 67984 Lantern, Tuff lite, 4D Each 1 Cart 4/BX C 73713 Loom woven Wool blanket - Blue Each 50 Cart 5 60365 Luer Adapter - Multi Sample 100/Box Box 1 Cart 3/ Shelf 2 49661 Nasal Cannulas, Adult Each 1 Cart 3/BX E 49660 Nasal Cannulas, Infant/Pediatric Each 1 Cart 4/BX E 52453 Nebulizer Kit, Disposable (Pulmo-Aide) Each 20 Cart 3/BX F 68197 Nitriderm Surgical Gloves Non-Latex - size 6.5 25/Box Box 1 Cart 2/BX B 68199 Nitriderm Surgical Gloves Non-Latex - size 7.5 25/Box Box 1 Cart 2/BX B 68222 Obstetrical Kit Kit 1 Cart 3/ Shelf 2 46080 Peak Flow Meter - disposable mouth 100/Box Box 1 Cart 4/ Shelf 1 piece - Standard 43735 Peak Flow Meter - Standard range Each 1 Cart 3/BX D 56431 Pediatric Band-aids - Seaseme Street 100 Box 2 Cart 3/BX C 12985 Pocket Mask replacement one-way valves Each 10 Cart 3/BX G 62414 Privacy Partitions Each 3 Trailer Floor 58724 Pulse Oximeter Each 1 Cart 4/ Shelf 1 72948 Pulse Oximeter Charger Each 1 Cart 4/ Shelf 1 59404 Respirator, N-95 with One-Way Valve 10/Box Box 1 Cart 4/ Shelf 4 62167 Safety Glasses Each 5 Cart 4/BX C 52917 Safety Pins Size#1 144 Bag 1 Cart 3/BX D 52918 Safety Pins Size#2 144 Bag 1 Cart 3/BX D 52919 Safety Pins Size#3 144 Bag 1 Cart 3/BX D 65917 Sensicare Non-Latex Power-free 100/Box Box 2 Cart 2/BX A exam gloves - Large 65916 Sensicare Non-Latex Power-free 100/Box Box 2 Cart 2/BX A exam gloves - Medium 65915 Sensicare Non-Latex Power-free 100/Box Box 2 Cart 2/BX A exam gloves - Small 65918 Sensicare Non-Latex Power-free 100/Box Box 2 Cart 2/BX A exam gloves - X-Large 43844 Shears, paramedic Each 2 Cart 3/BX D 46675 Sheets, Disposable 50/Case Case 2 Cart 2/ Shelf 3 63137 Spill Kit - EZ Clean spill kit Each 1 Cart 3/BX F 13935 Sterile Water - 1000ML 12/per Case 1 Cart 3/ Shelf 4 45311 Sterile Water - 250ML 12/per Case 1 Cart 3/ Shelf 4 15071 Sterile Water - 500ML 12/per Case 1 Cart 3/ Shelf 4 66248 Stethoscopes - Each 10 Cart 2/ Shelf 2 66246 Stethoscopes - Pediatric Each 10 Cart 2/ Shelf 2 72618 Suction Catheter Mini soft Kits Each 1 Cart 3/BX G 62785 Suction Catheters - 6FR Each 3 Cart 3/BX G 62786 Suction Catheters - 8FR Each 3 Cart 3/BX G 62787 Suction Catheters - 10FR Each 3 Cart 3/BX G 62788 Suction Catheters - 12FR Each 3 Cart 3/BX E 62789 Suction Catheters - 14FR Each 3 Cart 3/BX G 62792 Suction Catheters - 16FR Each 3 Cart 3/BX G 62793 Suction Catheters - 18FR Each 3 Cart 3/BX G 54024 Surgical Masks w/face shields 50/Box Box 1 Cart 3/BX D 34856 Surgilube (5 gram packet) 144/PktsBox 1 Cart 3/BX C 59699 Syringe (30cc) - 40 per/ box (Syringe only) 40/ Box 1 Cart 3/ Shelf 1 36837 Syringe, Self-sheathing, 10cc 100/Box Box 1 Cart 3/ Shelf 1 36825 Syringe, Self-sheathing, 3cc 100/Box Box 1 Cart 3/ Shelf 1 36826 Syringe, Self-sheathing, 5cc 100/Box Box 1 Cart 3/ Shelf 1 71569 Tape, 1" x 10 yd (hypo) 12 Rls/Box 1 Cart 3/BX C 71571 Tape, 3" x 10" yd (hypo) 4 Rls/Box 1 Cart 3/BX D 49317 Tegaderm Transparent Dressing 100/Box Box 1 Cart 3/BX D 64635 Thermometer, Digital Each 10 Cart 3/BX A 53612 Thermometer, Genius - Kendall Each 1 Cart 3/BX B 42929 Throat Lozenges 300 bag 2 Cart 3/BX D 69618 Tongue Depressors 100/Box Each 1 Cart 3/BX D 55619 Tracheostomy Care Set w/Hydrogen Peroxide Each 3 Cart 4/BX B 51736 Triple Antibiotic Ointment (1 gram) 144 Box 2 Cart 3/BX B 70748 Underpads (“Blue” Pads) 300 case 1 cs Cart 4/ Shelf 4 11706 Urinal, Male, disposable 12/Case Case 1 Cart 2/ Shelf 2 62812 Urinary Drainage Bag Each 3 Cart 3/BX F 66482 Wound Care cleaner Spray - 12oz bottle Each 1 Cart 3/BX B 43068 Wound Dressing (Sorbsan) - 3" x 3" 10/per Box 1 Cart 3/BX B IV Needle, 14g - Catheter 50/Box Box 1 Cart 3/ Shelf 1 IV Needle, 16g - Catheter 50/Box Box 1 Cart 3/ Shelf 1 IV Needle, 18g - Catheter 50/Box Box 1 Cart 3/ Shelf 1 IV Needle, 20g - Catheter 50/Box Box 1 Cart 3/ Shelf 1 IV Needle, 22g - Catheter 50/Box Box 1 Cart 3/ Shelf 1 IV Needle, Butterfly, 25g 50/Box Box 1 Cart 3/ Shelf 1 Lancet (Use with glucometer) 150/Box Box 1 Cart 3/BX A Needle, 20g x 1-1/2" - For Syringes 1 Cart 3/ Shelf 1 Needle, 22g x 1-1/2"- For Syringes 1 Cart 3/ Shelf 1 Needle, 25g x 1"- For Syringes 1 Cart 3/ Shelf 1 Oxygen Cylinder, E size, Aluminum Each 02 Cart Oxygen Humidifiers Case Cart 4/BX A Oxygen Regulator (Single DISS Connection) Cart 4/BX A Oxygen Supply Tubing Case 1 Cart 4/BX A Suction Sys w/lg bore Yankauer, Adult Each 1 Cart 4/BX B (Res-Q-Vac or equiv) Suction System Replacement Kits, Adult Each 2 Cart 4/BX B (includes Yankauer and canister) Suction System, Battery operated Each 1 Cart 4/BX B (S-Scort III or equivalent) Suction System, Replacement canisters Each 1 Cart 3/ Shelf 1 for S-Scort III or equivalent) Syringe (1cc) ? Cart 3/ Shelf 1 Syringe, 30cc 50/Box Box 2 Cart 3/ Shelf 1 Syringe, 60cc 25/Box Box 3 Cart 3/ Shelf 1 In Warehouse Thermometer, Digital Probe Covers Cart 3/BX A Thermometers, Pacifier Each 15 Cart 3/BX A Trailer (24 ft L x 8 ft. W) 1 Patient Care Equipment Refrigerator Small 1 Trailer Floor Sanitary Napkins 250/CS Regular 1 dozen Cart 3/ Shelf 4 Signage Trailer Floor dozen 1 Can opener, Manual 1 Cart 4/BX C Diapers, adult, disposable, Med./large 72/CS 1 Cart 2/ Shelf 4 Diapers, baby, disposable, Med./large 96/CS 1 Cart 2/ Shelf 3 Formula, Infant, Powdered and Liquid Case 1 Cart 2/ Shelf 2 Identification Bracelets 1000/BX Each 1 Cart 1/ Shelf 2 70699 Disposable Pillow 50 case 3 Cart 2/ Shelf 3 77007 Disposable Pillowcase 100 case 1 Cart 2/ Shelf 3 77006 Disposable Towels - Mauve 2 ply 500 case 3 Cart 2/ Shelf 4 73046 Walker, Folding Each 1 68754 Washclothes Disposable 50 Pack 3 Cart 2/ Shelf 4 58536 Wheelchair Each 2 Trailer Floor Chair, Folding 4/Ctn. 4 ctn Trailer Floor Food Tables (Folding Snack Size) Each 2 Trailer Floor Table, Folding 72" x 30") Each 1 Trailer Floor Adult Cots Each 50 Trailer Floor Pads for cots Each 50 All on Cart 5 Child Cots Each 5 Trailer Floor Hand Carts Each 2 Trailer Floor Tab D-3—Medical Needs Shelter Signs Interior- Squarecade 36” Type Quantity Registration 2 (with detachable arrows) Enter 4 (with detachable arrows) Do Not Enter 4 Triage (with arrows) 2 (with detachable arrows) Medical Needs Shelter Area 4 American Red Cross Area 4 Medical Needs Shelter Rules 4 (erasable board) Cafeteria 2 Arrows 4 (detachable) Exterior – Squarecade 45” Type Quantity Emergency Vehicles Only 2 Drop Off Area 2 Pick Up Area 2 Medical Needs Shelter 2 American Red Cross Shelter 2 TAB E—Job Action Sheets (JAS) Medical/health professionals should only perform those duties consistent with their level of expertise and only according to their professional licensure/certification and allowable scope of practice. Administrative Officer Administrative Support Logistics Officer Mental Health Professional MNS Medical Director MNS Site Director Nurse Patient Care Technician Respiratory Therapist Triage Officer ADMINISTRATIVE OFFICER JOB ACTION SHEET 1.) To oversee administrative support of the MNS. 2.) To act as a liaison between the MNS and DNG. Reports to: MNS Medical Director NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Maintain contact between the MNS and DNG. Apprise the MNS Medical Director of important incoming information. Provide the Triage Officer with administrative support staff as needed. Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Report concerns to the MNS Medical Director Remind personnel to clean up areas upon termination ADMINISTRATIVE SUPPORT JOB ACTION SHEET To provide administrative support for MNS operations. Reports to: Administrative Officer NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Maintain communication between all areas involved. Maintain security and safety of staff and occupants. Work together with Security Officer at facility and local enforcement agencies. Post signs guiding traffic throughout MNS. Control access to MNS staff, patient, ALS, family members/caregivers. Establish one main entrance for the flow of occupants into the shelter. Work with MNS Site Director and facility safety / security officer to set up security. Post security staff on outside doors and for fire watch, if available. Monitor parking and drop off areas. Respond to emergencies in the shelter as needed. Assist in locating lost persons and/or property. Provide all administrative support including copying, documentation, form completion, filing, etc. Retain all requisitions, supply lists, purchase orders and receipts. All information will be forwarded to the MSO for cost recovery processes. Work in specific areas of MNS to provide administrative support (i.e. triage). Provide registration assistance to ARC, as needed. Assist in minor patient care (transport, feeding, etc.), as needed. Assist in providing food/beverages to patients, as needed. Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Report concerns to the Administrative Officer. Remind personnel to clean up areas upon termination LOGISTICS OFFICER JOB ACTION SHEET To serve as the primary staff officer for MNS Medical Director for all matters concerning logistics. Reports to: MNS Medical Director NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Set up MNS Shelter to receive patients. Perform shift reviews to assess needs of MNS. Reorder supplies as needed. Oversee housekeeping, trash and medical waste disposal. Ensure disposal of trash and medical waste. Ensure that housekeeping activities are completed. Work directly with American Red Cross to ensure adequate food service is provided to shelter residents. Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Report concerns to the MNS Medical Director. Remind personnel to clean up areas upon termination MENTAL HEALTH PROFESSIONAL JOB ACTION SHEET 1.) To assess the mental health needs of the patients, their caregivers, and staff in the MNS and providing crisis management or referral. 2.) To assess the mental health needs of staff. Position Reports to the MNS Site Director Required Credentials: Licensed Mental Health Professional NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Assist with establishing the Patient Area. Assist patients with needs as indicated obtaining needed resources and referral to other agencies. Assess patients, their caregivers, and staff for signs of stress or anxiety and provide intervention as needed. Remind personnel to clean up areas upon termination. Participate in/complete after-action requirements. MNS MEDICAL DIRECTOR JOB ACTION SHEET To provide supervision, administration, and medical oversight for the MNS. Position Reports to Required Credentials: Delaware licensed physician NAME: ____________________________________________________________________ DATE: ____________________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Provide patient census to SHOC. Ensure the needs of the shelter occupants are being met. Report shelter needs to SHOC Operations. Conduct staff meetings to update shelter operations and needs. Maintain communications with MNS Site Director and Administrative and Logistics Officers. Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Remind personnel to clean up areas upon termination Participate in/complete after-action requirements MNS SITE DIRECTOR JOB ACTION SHEET To establish and oversee set-up and operations of MNS. Position reports to: MNS Medical Director NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag Establish and maintain contact with ARC Shelter Manager and SHOC. Delegate responsibilities and check sheets to each team leader. Develop and plan space at location. Complete a check and verify that the shelter is ready for operation before it opens to public. Establish areas of shelter for patient care assigned to that room. Assign personnel within designated area. Work with medical support staff to ensure appropriate care. Set up treatment areas as indicated. Ensure all supplies and records for designated areas are handled properly. Anticipate needs on census and patient needs and communicates with support staff. Advise Medical Director of any changes in condition of the patient(s). Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Report concerns to the MNS Medical Director. Remind personnel to clean up areas upon termination NURSE JOB ACTION SHEET To deliver appropriate health/medical services. Reports to: MNS Site Director Required Credentials: Registered Nurse licensed to practice in Delaware NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Assess the physical condition of the patients on an ongoing basis. Maintain the patient’s medical update form. Advise the MNS Site Director of any adverse change in condition of patients. Monitor those patients receiving oxygen and refers to respiratory therapist if problems occur. Deliver care and assistance to residents as required, following approved protocols, procedures and guidelines and/or as directed by the MNS Medical Director. Work with family members/caregivers to assist with rendering care to the patients. Refer patients who need immediate medical attention to physician and/or contact 911. Maintain standard precautions and infection control. Participate in health/medical briefings at beginning and end of each shift or while on shift. Assess emotional needs of residents and coworkers. Monitor the physical environment for safety or environmental risk. Oversee patient care technicians in delivery of care to patient. Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Report concerns to the MNS Site Director. Remind personnel to clean up areas upon termination PATIENT CARE TECHNICIAN JOB ACTION SHEET To provide general assistance to the Nursing staff in caring for patients. Reports to: Nurse Required Credentials: Either Licensed Practical Nurse or EMT (B) authorized to practice in Delaware NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Communicates needs to RN. Assist with patient care such as feeding, transporting, bathing, changing linens, etc. Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Report concerns to one of the nurses. Remind personnel to clean up areas upon termination RESPIRATORY THERAPIST JOB ACTION SHEET To monitor respiratory status of MNS patients Reports to: MNS Medical Director NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Regularly monitor respiratory status of MNS patients. Notify RN of any changes in respiratory status Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Report concerns to your direct report. Remind personnel to clean up areas upon termination TRIAGE OFFICER JOB ACTION SHEET To provide medical assessment for all patients entering the MNS. Reports to: MNS Medical Director NAME: _________________________________________________________ DATE: _________________________________________________________ Read Job Action Sheet and review organizational chart. Put on nametag. Perform all triage functions for MNS patients. Complete Initial Evaluation Sheet (MNS Form E-2) upon patient arrival. Observe patients and staff for stress and fatigue. Observe all staff, and patients for signs of stress and inappropriate behavior. Report concerns to your direct report. Remind personnel to clean up areas upon termination TAB F—Memoranda of Understanding 1.0 Copies of Memorandum of Understanding (MOU) are kept with the Division of Public Health (DPH) Medical Needs Shelter Plan Final, July 2008 Division of Public Health, State of Delaware Doc Control # 35-05-20/08/05/19B