IMS SERIES: Staffing and Planning for a Special Needs Shelter
While IMS may not be able to assist you in staffing your special needs shelter, we wanted to share some common guidelines for tackling this challenge. Remember that when planning for and purchasing for your shelter, housing these staff members will also be a challenge so make sure you have the necessary lodging requirements for these people as well.
These guidelines will change with each jurisdiction, but are simply some “best practices” guidelines:
Your special needs shelter should be under the direct supervision of an on-site licensed medical professional such as an RN, physician or an advanced nurse practitioner or physician’s assistant.
As for other staffers, consult your local plans, protocols and procedures for those roles and what their limitations may be when it comes to their operational duties or ability to treat patients.
A licensed physician should be available for immediate medical consultation by telephone or in person. This may tend to become more difficult over extended periods of time such as what we experienced during Hurricane Harvey, but the rule of thumb is that this access is at least for 72 hours and then the minimum would be to have that professional available by phone and in close proximity.
As soon as possible, but at a minimum of 72 hours of continued
shelter operations, and every 24 hours thereafter, the physician should evaluate shelter occupants with medical special needs and approve standard nursing protocols for the medical special needs shelter staff. The standard nursing protocols should be developed
for the shelter at the local level. It is recommended that a psychiatrist be designated on-call for medication consultation to the shelter physician.
Experienced caregivers, including certified nurse assistants; personal care attendants; nursing aides; home health aides; companions; EMTs; respiratory, physical, and occupational therapists; medical or nursing students; and orderlies may be used to assist with providing care under the supervision of a licensed medical professional.
At least one person currently trained in cardiopulmonary resuscitation (CPR) or Basic Life Support should be in the shelter at all times, and it is recommended that two people trained in CPR be present, if possible. It also is recommended that at least one person trained in the use of automated external defibrillators should be in the shelter
at all times, if possible.
Don’t forget that at least one person familiar with the management of oxygen therapy to handle respiratory problems and adjust and monitor oxygen is also recommended. This person could be a respiratory therapist, oxygen company representative, RN, LPN, or respiratory
Physical and occupational therapists may be needed to assist shelter occupants with their routine daily activities and with transfer assistance if the shelter is open for an extended period of time.
Of course, the shelter staffing pattern should be adjusted based on the actual numbers and needs of individuals with medical special needs in the shelter. Ideally, there should be one caregiver for every 15 shelter occupants.
Keep in mind when planning and purchasing for your shelter that you consider what your local “levels” are at current and permanent medical facilities as this will give you a guide to what you can expect, for example, if your local hospital experiences 30% of its patients with breathing issues, 8% bariatric, 13% adolescent, etc, it is logical to assume that this may be represented in your special needs shelter which could, while not being an exact science, a great way to plan and purchase your cots and supplies.
Remember your staff. If possible, medical special needs shelter staff members should not be scheduled to work for more than 12 consecutive hours in a 24-hour period. As of late, medical journals and responder trade magazines have been publishing articles showing the staggering consequences of over-tired responders and medical personnel.
While this is all pursuant to your local protocols and established guidelines, we hope this installment of our blog has helped you to think beyond the normal thought processes of planning and has given you some helpful insight into how to plan for your special needs sheltering.