# Presentation: 942660

## Panel PresentationJob Corps Health and Wellness Conference June 8, 2005 Orlando, Florida

***Moderator: Natalie Conner, MS, RN***
***San Francisco Region Nurse Consultant***

**Responding to Major Medical Crises on Centers**

## Panel Members

- P-Jay Smith, RN
- 	Health and Wellness Manager, Fort Simcoe
- Nanci Cargill, RN
- 	Health and Wellness Manager, Columbia Basin
- Jeri Warren, PhD
- 	Regional Mental Health Consultant
- Joann Stroman, RN
- 	Health and Wellness Manager, Bamberg
- Diane Geeting, RN
- 	Regional Nurse Consultant

## Objectives

- Identify common features of tragic incidents such as  student deaths or disasters and medical crises such as infectious disease outbreaks
- Identify resources that may be available in the local community or on line (via the web) that could assist with advance planning for an emergency response

## Objectives (continued)

- Define what grief counseling and critical incident debriefing are, and how they are utilized after tragic incidents
- Begin to develop a plan to address or improve how emergencies are handled at your center

## Fort Simcoe Job Corps CenterP-Jay Smith, RN

- Civilian Conservation Center
- White Swan, Washington
- Near Yakima, rural area
- Native American
- Reservation
- U.S. Dept. Of Interior
- Bureau of Reclamation
- Center Capacity: 224

## Columbia BasinJob Corps CenterNanci Cargill, RNHealth and Wellness Manager

## Columbia Basin Job Corps Training For The Future

**Columbia Basin Job Corps ****Training For The Future**

## The Center has a 2 mile perimeter and covers a total of 43 acres.

## Slide 9

## Moses Lake, Washington

- 176 miles east of Seattle, 106 miles west of Spokane

## Columbia Basin Job Corps

- Near the world famous Grand Coulee Dam
- Built in 1943 during World War II as an airbase to train Army Air Corps bomber crews
- Two blocks from Grant County International Airport and 4 miles from downtown Moses Lake
- Opened in 1965
- Operated by the Bureau of Reclamation, U.S. Department of the Interior

## CENTER GRADUATES:

- 14 – 18 STUDENTS COMPLETE EACH MONTH

**LARGEST NUMBER OF GRADUATES**:
- COMPLETE FROM THE MEDICAL TRADES – NURSING & PHARMACY TECH

**CENTER CAPACITY:**
- 175 Males
- _+ 75 Females_
- 250
**STUDENTS SCREEN                 IN FROM:**
- WASHINGTON, OREGON, CALIFORNIA, IDAHO

##  *Vocational Trades*

** *****Vocational Trades***

**Business                      Cement****	****              Welding                       Pharmacy Tech.          Nursing/Phlebotomy**

**Plastering****	****                   Carpentry ****	****               Painting                      Maintenance                Culinary Arts    ****	****	**

##  *Vocational Trades*

- Computer Operator/Cisco Networking                     ACT-Advanced Career Training
- 					Students have the ability to complete a 						2 year AA degree while enrolled in the 						program.

## HEALTH AND WELLNESS 

- HEALTH AND WELLNESS
- CENTER

- OPEN HOURS:
- 7:00-7:45
- 11:30-12:30
- 4:45-5:30
- USUALLY 50 STUDENTS/DAY PRESENTING TO            OPEN HOURS
- 2 STUDENTS PER DAY IN OBSERVATION ROOM

## Residential Living

- Four dormitories on the center
- 3 for males
- 1 for females (two-story building)
- The majority of the students enrolled live in the dorms on center
- There are also non-resident students who reside in the Moses Lake area

## Flu Epidemics

- Typically occur during winter months
- Average of 36,000 deaths/year during 1990-1999
- Highest rate of death:
- Age 65 and over
- The very young
- Pregnant women
- Persons of any age with chronic medical conditions

## Flu Epidemics

- Influenza A & B – two most common types causing epidemic human disease
- Spread from person to person through coughing and sneezing
- Incubation period – 1 to 4 days with an average of 2 days

## Flu Epidemics

- Control of influenza by vaccination for high risk groups and medical staff then general population during October and November
- Manufacturer projections for vaccine: 90-100 million doses for 2004-2005

## Grant County Health DistrictEmergency Procedures

- Responds to any outbreak when notified by primary physician for that agency
- Response consists of testing those showing signs & symptoms of flu
- Test Influenza A & B
- Strep Testing
- Mono Testing

## Grant County Health DistrictEmergency Procedures (continued)

- Triage patients based on condition
- Reduce possibility of spreading by isolating those with and without symptoms
- Done by modifying dorm arrangements
- Administer medications

## Grant County Health DistrictEmergency Procedures (continued)

- Investigated the source by:
- Tracking contacts outside the Center
- Asked people to minimize their travel in and out of the Center as much as possible
- Provided the community with information through the news media
- Analyze effectiveness and modify the plan if needed

## Number Of Students Presenting With Flu Symptoms

## Percent of OBS (250) on Observation Restrictions

## ResourcesInfluenza Information

- General information
- 	_[http://www.cdc.gov/flu/professionals](http://www.cdc.gov/flu/professionals)_
- Pandemic planning
- 	_[http://www.dhhs.gov/nvpo/pandemicplan/](http://www.dhhs.gov/nvpo/pandemicplan/)_
- Annex 2: Draft Health Care System Guidelines
- Vaccine supply and priorities
- HCWs vs. air traffic controllers and utility workers
- Staffing interventions
- Who lives in walking distance of center??
- Infection control
- Chemoprophylaxis issues
- In pandemic, initially anti-virals for HCWs but then will be saved and used for treatment only
- Triage and clinical evaluation

## Critical Incident DebriefingJeri Warren, PhDRegional Mental Health Consultant

## ResourcesCritical Incident Debriefing

- _[http://www.nasponline.org/NEAT/neat_crisis.html](http://www.nasponline.org/NEAT/neat_crisis.html)_
- Trauma Intervention Programs Inc
- 	“Citizens helping citizen in crisis”
- 	Has chapters throughout the country
- 	_[http://tipnational.org/](http://tipnational.org/)_
- Checklist for survivors
- 	_[http://www.tipsandiego.org/TIPWhatYouCanDo.htm](http://www.tipsandiego.org/TIPWhatYouCanDo.htm)_

## BambergJob Corps CenterJoann Stroman, RNHealth and Wellness Manager

## Resources: Disaster PreparednessDiane Geeting, RNRegional Nurse Consultant

## Disaster Supplies KitShelter-in-Place in an Emergency

- Stock six basics in your home:
- Water
- Food
- First aid supplies
- Clothing and bedding
- Tools and emergency supplies
- Special items
- Keep in an easy-to-carry container
- Backpack, duffle bag, large covered trash container
- Suggested items marked with an asterisk(*) on following slides

## Disaster Supplies KitWater

- Keep a three-day supply per person (two quarts for drinking, two quarts for food preparation/sanitation daily)*
- Store in plastic containers such as soft drink bottles
- Avoid breakable containers, such as milk cartons or glass bottles
- Two quarts drinking water per day is minimum; double amount for hot environment, increased activity, children, nursing mothers, ill person

## Disaster Supplies KitFood

- Store a three-day supply of non-perishable food
- Ready-to-eat canned  items
- High energy
- Vitamins
- Comfort/stress foods
- Require no refrigeration, preparation, or cooking, and little or no water

## Disaster Supplies KitFirst Aid Kit

- One for home, one for each car
- (20) adhesive bandages, various sizes
- (1) 5" x 9" sterile dressing
- (1) conforming roller gauze bandage
- (2) triangular bandages
- (2) 3 x 3 sterile gauze pads
- (2) 4 x 4 sterile gauze pads
- (1) roll 3" cohesive bandage
- (6) antiseptic wipes

## Disaster Supplies KitFirst Aid Kit (continued)

- (2) germicidal hand wipes or waterless alcohol-based hand  sanitizer
- (2) pair large non-latex gloves
- Adhesive tape, 2" width
- Anti-bacterial ointment
- Cold pack
- Scissors (small, personal)
- Tweezers
- CPR breathing barrier, such as a face shield

## Disaster Supplies KitNon-Prescription Drugs

- Aspirin or non-aspirin pain reliever
- Anti-diarrhea medication
- Antacid (for stomach upset)
- Syrup of Ipecac (use to induce vomiting if advised by the Poison Control Center)
- Laxative
- Activated charcoal (use if advised by the Poison Control Center)

## Disaster Supplies KitTools and Supplies

- Mess kits, or paper cups, plates, and plastic utensils*
- Emergency preparedness manual*
- Battery-operated radio and extra batteries*
- Flashlight and extra batteries*
- Cash or traveler's checks, change*
- Non-electric can opener, utility knife*

## Disaster Supplies KitTools and Supplies (continued)

- Fire extinguisher: small canister ABC type
- Tube tent
- Pliers
- Tape
- Compass
- Matches in a waterproof container
- Aluminum foil
- Plastic storage containers

## Disaster Supplies KitTools and Supplies (continued)

- Signal flare
- Paper, pencil
- Needles, thread
- Medicine dropper
- Shut-off wrench, to turn off household gas and water
- Whistle
- Plastic sheeting
- Map of the area (for locating shelters)

## Disaster Supplies KitSanitation

- Toilet paper, towelettes*
- Soap, liquid detergent*
- Feminine supplies*
- Personal hygiene items*
- Plastic garbage bags, ties (for personal sanitation uses)
- Plastic bucket with tight lid
- Disinfectant
- Household chlorine bleach

## Disaster Supplies KitClothing and Bedding

- *Include at least one complete change of clothing and footwear per person
- Rain gear*
- Blankets or sleeping bags*
- Sturdy shoes or work boots*
- Hat and gloves
- Thermal underwear
- Sunglasses

## Disaster Supplies KitSpecial Items: For Baby*

- Formula
- Diapers
- Bottles
- Powdered milk
- Medications

## Disaster Supplies KitSpecial Items: For Adults*

- Heart and high blood pressure medication
- Insulin
- Prescription drugs
- Denture needs
- Contact lenses and supplies
- Extra eye glasses

## Disaster Supplies KitSpecial Items

- Entertainment
- Games and books
- Important Family Documents
- Keep records in a waterproof, portable container
- Will, insurance policies, passports, social security cards, immunization records, bank account numbers, credit card numbers and companies
- Family records (birth, marriage)
- Inventory of valuable household goods, important phone numbers

## Disaster Supplies KitGeneral Information

- Store kit in convenient place known to all family members
- Keep smaller version of supplies kit in trunk of car
- Keep items in airtight plastic bags
- Change stored water supply every six months so it stays fresh

## Disaster Supplies KitGeneral Information (continued)

- Replace stored food every six months
- Re-think your kit and family needs at least once a year; replace batteries, update clothes, etc.
- Ask your physician or pharmacist about storing prescription medications

## Disaster Supplies Kit Resources

- To get copies of American Red Cross Community Disaster Education materials, contact your local Red Cross chapter
- "Disaster Supplies Kit" developed by the Federal Emergency Management Agency and the American Red Cross

## Policies and ProceduresExamples of Center SOP/Protocols

- CRITICAL (Serious) INCIDENT    PROTOCOLS
- SHRIVER JOB CORPS CENTER
- Adams and Associates Inc.

## Definition of Terms

- A Center Critical Incident is one in which Shriver Job Corps Center as a whole, or a large segment of the center, is affected.  Examples might be (1) death or life threatening illness of a student or staff (2) a violent incident within the school; (3) a natural disaster, e.g. flood, fire, hurricane; (4) a man-made disaster, e.g. explosion, terrorist attack, war.

## Team Members

- The Center Critical Incident Response Team will be comprised of the Center Director, Deputy Center Director, Director Finance and Administration, Group Life Director,  Safety/ Security Supervisor, Wellness Manager, State Police and Fire Officials. At times it may be necessary to add additional personnel to the team.

## Team Members (continued)

- The team will meet 4 times a year to review and update the Critical Incident Protocols.
- In the event that the Center Director is not available the next _Senior Staff Member_ will direct the team.

## Response to a Center Critical Incident

- Center Critical Incident Team should assemble and oversee the response as soon as possible.
- The emergency response protocol should be followed.
- The center’s administrative section will verify the facts and check for the accuracy of the information.

## Response to a Center Critical Incident (continued)

- The team should make a determination of the information to be shared and to whom it will be given (with attention to issues of privacy and confidentiality).
- Alert the essential center personal by way of phone, email and radio.
- _Code 100_ will be the notification message triggering action.

## Response to a Center Critical Incident (continued)

- All other center staff will be alerted to the situation and provided with the information they need to know.
- Department heads will meet with students and other staff in small groups to disseminate information and to dispel rumors.
- Vulnerable students and staff will be identified.
- Designated staff will notify parents of the incident via the most efficient means of communication as soon as possible.  This may mean establishing a telephone chain, special student assembly.

## Response to a Center Critical Incident (continued)

- Prevention strategies might include violence prevention programs, peer counseling, tolerance programs, and the everyday emphasis on cultivating compassion, respect, and tolerance among student and staff.
- Post-prevention strategies include procession and critiquing of the center response to crises which occur, and the ongoing refinement and revision of prevention and intervention strategies.

## Center Director’s Checklist 

- 	This checklist is provided as a general guide for designated staff to follow for critical incidents not otherwise covered in this manual.
- 	**______1. CONDUCT AN IMMEDIATE ASSESSMENT**
**	****A. Confirm and ascertain the type of incident**
**	****B. Obtain essential information (what happened, who was involved, what did witnesses see, how was the incident started, etc)**
**	****C.  Notify DOL**
**	****______2. SUMMON HELP**
**	****A. Call 9-1-1.  Have someone stay on the line with the 9-1-1 operator.**
**	****B. Implement site critical incident plan. **_**CODE 100**_
**	****C. Gather staff assigned to emergency duties.**
**	****D. Direct staff to a safe area **

## Military Conflict or National Incident

- Verify information, gather details.
- Share facts with faulty via memo or meeting.
- Discuss what has happened with the students, encouraging them to share their emotional reactions to the tragedy.
- Consult with counselor about any especially distressed students.
-  Hold an after-school faculty meeting to discuss how the students are responding and to clarify helpful approaches or further steps in dealing with the tragedy.
- Hold a community-wide meeting to facilitate further discussion concerning the incident as necessary.

## Summary

- Traumatic events
- Interrupt our routine
- Change the way we do business
- Creates stress; fight or flight
- Creative thinking may be necessary; “make do” or think outside the box
- Preparation can improve outcomes

## Questions for Panel Members?

- Natalie Conner, RN
- 	Regional Nurse Consultant
- P-Jay Smith, RN
- 	Health and Wellness Manager, Fort Simcoe
- Nanci Cargill, RN
- 	Health and Wellness Manager, Columbia Basin
- Jeri Warren, PhD
- 	Regional Mental Health Consultant
- Joann Stroman, RN
- 	Health and Wellness Manager, Bamberg
- Diane Geeting, RN
- 	Regional Nurse Consultant