Health Aspects of Evacuation and Shelter

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Health Aspects of Evacuation and Shelter

• Emergency Preparedness
• Department of Health

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a game of two halves

• Evacuation getting people out
• Shelter receiving those who have been
  evacuated

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Evacuation

• The decision to evacuate
• What are the indications?
• How much notice to evacuate?
• How long will the evacuation be for?
• Will we evacuate everyone?
• Will we evacuate hospitals?

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Who are we evacuating?

• Three categories -
• General population
• Those with special needs
• Those in hospital or residential care facilities

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General population

• General advice -
• Need to take any medications repeat
  prescriptions
• Baby foods and fluids
• Food and fluid for the journey
• Special food/dietary needs
• The basics - a first aid kit!

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Those with special needs

• Individuals need to be identified before
  evacuation
• Detailed plans for their evacuation made
• Type and size of transport for special
  chairs/beds
• Transport may not be able to make round trips
• Carers needs
• Arrangements made for reception and on going care
• Do not plan for ambulances to be available

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Hospital and residential care

• Need as much notice as possible
• This will need to be a local decision
• Cannot rely on ambulances being available to
  evacuate patients
• Most evacuation plans are for horizontal
  evacuation in the event of fire
• No recent experience in UK of whole hospital
  evacuation

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Hospitals and residential care

• Bed occupancy rates
• Will staff move with patients?
• What other facilities than hospitals can be used?
• Probably unable to move much kit and equipment

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Receiving those evacuated

• Assume most care can be managed at receiving
  facility
• Need good quality triage
• Hospital
• Ambulatory care centre
• General population primary care needs
• Need to treat injuries sustained in the incident
  or evacuation

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Medical History and medication

• People may have no medical history or medication
  record with them
• Many will have left with no medication
• Need a system for dispensing prescription
  medication
• Chronic conditions may have destabilised in the
  incident/evacuation eg diabetes, asthma
• Need to have arrangements for those needing
  regular treatment eg Renal dialysis

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Public Health Issues

• Sports facilities are not designed for 24/7
  occupation by large numbers of people!
• Toilet and hand washing facilities not sufficient
• Use of alcohol hand scrub
• Microbiological safety of -
• Water supplies
• Food sources

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Surveillance

• Epidemiological surveillance can identify
  outbreaks of communicable disease early
• Need for rapid intervention
• ?quarantine/isolation
• There may be need for mass vaccination/
  prophylaxis

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Risk communication

• Advice and behaviours need to be consistent
  gloves vs full PPE
• All staff should follow same risk assessment and
  behaviours

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Mental health

• Risk of significant distress following event/
  evacuation/uncertainty
• Post 7th July Study is assessing if can identify
  those who will develop PTS later
• Need to provide as safe environment as possible
  and reduce uncertainty
• Ensure frontline workers can recognise symptoms
  eg Family Liaison Officers

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Key Problems

• Morbid obesity
• Those requiring wheelchairs or other mobility
  aids
• People will not leave their pets!