Medical Area Setup
When you first arrive at the evacuation center, the most important thing to figure out is what organizational structure is already in place. If it is early in a disaster this may not be clear, but here are some important questions to ask:
- Who is running the shelter? (County? Red Cross?) This will help you know who to ask for supplies and volunteers. The Red Cross may provide a nurse but they usually provide only basic first aid. You can supplement that care by setting up a clinic type structure to do triage and treat minor/chronic issues.
- Who and where is the Shelter Manager? This person is responsible for the whole shelter – cots, food, volunteers etc., and will know if there are plans for a medical area already.
- Who is in charge of the facilities? This person may be able to help find the best place to locate a medical areas.
- Is there anyone in charge of Access and Functional Needs (AFN)? This team can help with getting equipment for disabled people, translation for non English speakers etc.
Set a time for a daily meting with the Shelter Manager, Facilities Director, Volunteer Coordinator, AFN Lead, Medical Lead (you?) and any other organizations (like Red Cross) to make sure you are all working together and not duplicating effort.
If there doesn't appear to be anyone in charge, you can start setting up a medical area recognizing that things are bound to evolve as more resources arrive to help.
Setting Up the Physical Space
Depending on the space available for the shelter, the set up may vary substantially. Often, working with facilities people you can find additional spaces that can be used to provide good care. There are sketches of possible set ups linked below. Remember to locate medical areas near electrical outlets so people can charge phones, access Mifi, etc.!
Utilizing Separate Buildings
If you are in a place with multiple buildings or rooms, such as a school or fairground, it is ideal to utilize separate buildings. In evacuation centers with more than about 200 people it is ideal to have a "clinic", a direct observation ward, and an isolation area with direct access to a bathroom and hand washing.
Clinic - The "clinic" should be centrally located so people can find it easily, have an intake table, where people are signed in and get simple OTC meds as well as a separate area with some privacy (screens work well) where providers can do exams and wound care. There should also be a table away from the public where medications and the chart file box are kept.
Direct Observation Ward - The direct observation ward is essentially a separate shelter area for medically frail people (and their families) with 24-hour nurses. There should be room for 20-30 cots as well as a table for a nursing station and access to a handicap accessible bathroom. In this controlled setting, cots can be numbered and a separate box with charts can be at the nurses station. With permission, you can also use a white board with a bed map and names.
Isolation Area - It is important to set up the isolation area early, especially if the evacuation shelter will be open for more than a few days. You will need a separate room with cots, a nurse's station and a dedicated bathroom. Use thisarea to house people who develop vomiting or diarrhea to prevent an outbreak of norovirus in the general shelter.
Medical Area in the Shelter Dormitory
If it is not possible set up the medical area separate from the general shelter, we recommend being centrally located but against a wall with a big sign. Use 3 tables to create a U and put chairs on the outside and inside the U. Use the table against the wall for medicines. Create a screened area to do exams and dressing changes.
Describing Where People's Cots Are
It can be very difficult to find people in the shelter since the space is often a large area such as a gym. In order combat that problem, be sure the cots are lined up in rows and create a grid based on the physical features of the room – aisles between cots, overhead supports etc. Number the rows and use letters for the divisions in the room so that you can describe someone's cot location as A3 or C1 etc. Try to create the divisions into areas with about 10 cots. Use painter's tape on the wall to label the numbered aisles and the lettered divisions.
Here is an idea of what this could look like. Bring a white board and some painters tape. On the white board make a map of the shelter with the aisles, overhead supports, doors, etc., labeled and the grid shown. Put that white board up by the medical area.
Consider getting a dedicated phone for each shelter medical station (prepaid cell phone works well). This is VERY helpful for managing volunteers, supplies, and coordinating with other agencies. Be sure to LABEL IT with the phone number! Look around the shelter to see if there are phone companies represented and ask them if they have any free phones. Consider using social media to ask for these kinds of donations. People want to help in a disaster!
If there is no wifi available but there is cell coverage, consider getting a Mifi device to provide wifi to up to 5 people at a time.
It can also be helpful to have people join a web based chat groups such as Slack (if you have cell or wifi coverage) so you can communicate with volunteers about needs and changing conditions.
Understanding the Organizational Structure of Disasters
It helps to understand incident command structure (ICS) and terminology (aka acronyms) used in a disaster. Here is a link to the most common acronyms used in disasters. PDF