a1 Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland USA
a2 Institute for Johns Hopkins Nursing, Baltimore, The Johns Hopkins University, Maryland USA
a3 Harvard Humanitarian Initiative, Harvard University, Boston, Massachusetts USA
a4 Division of International Health and Humanitarian Programs, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts USA
a5 Office of Critical Event Preparedness and Response, The Johns Hopkins University Medical Institutions, Department of Emergency Medicine, Baltimore, Maryland USA
a6 Department of Emergency Medicine, Boston University, Boston, Massachusetts USA
Introduction: During 2005, Hurricanes Katrina and Rita struck the US Gulf Coast, displacing approximately two million people. With >250,000 evacuees in shelters, volunteers from the American Red Cross (ARC) and other nongovernmental and faith-based organizations provided services. The objective of this study was to evaluate the composition, pre-deployment training, and recognition of scenarios with outbreak potential by shelter health staff.
Methods: A rapid assessment using a 36-item questionnaire was conducted through in-person interviews with shelter health staff immediately following Hurricanes Katrina and Rita. Data were collected by sampling at shelters located throughout five ARC regions in Texas. The survey focused on: (1) public health capacity; (2) level of public health awareness among staff; (3) public health training prior to deployment; and (4) interest in technical support for public health concerns. In addition, health staff volunteers were asked to manage 11 clinical scenarios with possible public health implications.
Results: Forty-three health staff at 24 shelters were interviewed. Nurses comprised the majority of shelter health volunteers and were present in 93% of shelters; however, there were no public health providers present as staff in any shelter. Less than one-third of shelter health staff had public health training, and only 55% had received public health information specific to managing the health needs of evacuees. Only 37% of the shelters had a systematic method for screening the healthcare needs of evacuees upon arrival. Although specific clinical scenarios involving case clusters were referred appropriately, 60% of the time, 75% of all clinical scenarios with epidemic potential did not elicit proper notification of public health authorities by shelter health staff. In contrast, clinical scenarios requiring medical attention were correctly referred >90% of the time. Greater access and support from health and public health experts was endorsed by 93% of respondents.
Conclusions: Public health training for sheltering operations must be enhanced and should be a required component of pre-deployment instruction. Development of a standardized shelter intake health screening instrument may facilitate assessment of needs and appropriate resource allocation. Shelter health staff did not recognize or report the majority of cases with epidemic potential to public health authorities. Direct technical support to shelter health staff for public health concerns could bridge existing gaps and assist surveillance efforts.
(Received November 12 2008)
(Accepted February 25 2009)
Brahmbhatt D, Chan JL, Hsu EB, Mowafi H, Kirsch TD, Quereshi A, Greenough PG: Public health preparedness of post-Katrina and Rita shelter health staff. Prehosp Disaster Med 24(6):500-505.