Special Needs

Special Needs

Example of necessary information to be placed on the Special Needs List.

Guidelines for Special Medical Needs Shelters

DEFINITION:

Special Medical Needs Shelters are designed for people whose age, frailty, mobility, functional and/or medical disability make them particularly vulnerable and at risk in disaster situations. Special Medical Needs Shelters are designed for those individuals who have pre-existing conditions resulting in medical impairments and who have been able to maintain activities of daily living in a home environment prior to the disaster or emergency situation.

Special Medical Needs Shelters are temporary, emergency-type facilities capable of providing special/supervised housing to individuals whose physical or mental condition exceeds the Red Cross Disaster Health Services' level of capability for basic first aid in emergency/disaster shelters but is not severe enough to require hospitalization.

Special Medical Needs Shelters are intended to provide a safe environment for those requiring limited medical assistance or surveillance due to a pre-existing health problem.

Special Medical Needs Shelters are not to be identified as a skilled care facility.

LIMITATIONS:

Admissions to Special Medical Needs Shelters are limited to level of care needed and resources available. Only those individuals meeting Category II criteria are eligible for admission.

Hospitals, Nursing Homes and Residential Care Facilities shall have disaster/emergency plans in place which assures the transfer of patients to appropriate, comparable facilities.

Home Health Services Agencies must establish emergency plans with patients/families upon admission to the program. Special Medical Needs Shelters are the resource of last resort for these individuals. If a caregiver is needed, the caregiver from home or Home Health Agency should be attending with the individual.

ADMISSION CRITERIA:

Category 1:

Category 1 indicates that these individuals require recurring professional medical care, special medical equipment and/or continual medical surveillance and must be considered for admission into a hospital:

Examples:

* 1. Ventilator dependent;

* 2. Persons requiring continuous IV therapy (pain control or hydration);

* 3. Oxygen dependent;

4. Pregnant women who are experiencing contractions and women who are in the seventh month or beyond should report to MD for possible wait at hospital;

5. Persons who report chest pain or have experienced chest pain in the last 24 hours;

6. Persons with shortness of breath;

7. Persons who have already experienced a potentially serious injury and have not been evaluated by a physician;

8. Persons with communicable diseases which require isolation;

9. Uncontrollable or violent persons;

10. Persons with infected wounds;

* 11. Comatose persons;

12. Others requiring the intensity of services provided at a hospital or Skilled Nursing Facility.

*If an individual with one of these medical conditions was homebound at the time of the emergency or disaster, he/she with the caretaker may report to a special medical needs shelter provided power sources, equipment and back-up supplies are available.

Category 2:

Persons in this category require some medical surveillance and/or special assistance. These are individuals whose age, frailty, mobility, functional and/or medical disability make them particularly vulnerable and at-risk in disaster situations. These are individuals with medical impairments who have been able to maintain activities of daily living in a home environment prior to the disaster or emergency situation. Individuals meeting these criteria should be assigned to a special medical needs shelter, if appropriate bedding, staffing, equipment, power sources and supplies are available. If a caregiver is needed, the caregiver from the home or home health agency must accompany and stay with the person at the shelter.

Examples:

1. Wheelchair bound persons with medical needs;

2. Individuals with severely reduced mobility;

3. Persons with mental illness who are non-violent;

4. Medically impaired individuals who are able to maintain activities of daily living with special assistance, such as:

a. Partial paralysis

b. Intermittent infusion

c. Various ostomies (colostomies, tracheotomies, etc.)

5. Persons with dementia who cannot be maintained at a Red Cross Shelter

* 6. Ventilator dependent;

* 7. Persons requiring continuous IV therapy (pain control, or hydration);

* 8. Oxygen dependent; and

* 9. Comatose persons.

Management considerations which impact the decision to hospitalize or admit to special medical needs shelters include, but are not limited to:

	access to constant power source for suction pumps, respirators or other machine usage;
	need to replenish medications and/or supplies;
	access to physician for diagnosis, treatment, change in orders, etc.
	potential for health status of individual to change rapidly due to stress, environmental conditions, etc.
	ability to transport to higher level of care quickly

Category 3:

Includes individuals who are independent prior to disaster or special emergency. Some of these individuals may have pre-existing health problems that do not impede activities of daily living. Needs of individuals in this category should not exceed the basic first aid capabilities of a Red Cross Shelter.

Examples of pre-existing health problems:

1. Persons with Epilepsy (if controlled);

2. Mild to moderate muscular dystrophy;

3. Diabetics who are stable;

4. Hemophilia;

5. Persons with prosthesis;

6. Vision or hearing impaired;

7. Asthmatics;

8. Persons with speech impediments;

9. Language/cultural barriers;

10. Wheelchair bound persons with no medical needs.

Individuals seeking admission to American Red Cross Shelters who have special medical needs that exceed the resource capabilities of the shelter, or the level of care needed exceeds the protocols of the American Red Cross may be referred to a Special Medical Needs Shelter.

CRITERIA FOR DESIGNATING SPECIAL MEDICAL NEEDS SHELTERS:

Essential elements in designating Special Medical Needs Shelters include but are not limited to the following:

1. Americans with Disabilities Act Accessibility ( ADA '92)

2. Emergency Power (fixed generators)

3. ARC Hurricane Selection Guidelines

4. Close proximity to emergency services

5. Refrigeration

6. 40-60 sq. ft. per individual/caretaker or 2-3000 sq. ft. per facility

7. Back-up oxygen supplies

8. Bathrooms (wheelchair accessible)

9. Water supplies and waste disposal system

10. Food supply and preparation area for special diets

11. Liquids for special dietary requirements, etc. (i.e.., orange juice, milk)

PREFERRED SITES FOR SPECIAL MEDICAL NEEDS SHELTERS:

Because individuals with pre-existing health conditions resulting in medical impairments have needs which exceed the basic first aid resources of a regular shelter but do not require hospitalization and because their medical condition may be exacerbated or their health status may deteriorate due to the disaster situation, the following are preferred sites for special medical needs shelters:

1. A large area within a hospital

2. Adjunct hospital facility (out patient surgery departments, physician services,

wellness centers)

3. Rehabilitation Centers

4. Other sites for considerations: Infirmaries, primary care centers, large

medical practice buildings

5. State buildings such as in-patient Mental Health facilities.

The least preferred site for Special Medical Needs Shelters is an area within American Red Cross Shelters. When such a facility is used, criteria for admission will be altered based on the limitations of the facility.