Online Program

Cot-to-cot: An evidence-based model for identifying client needs in disaster shelters

Monday, November 4, 2013

Janice Springer, DNP, RN, PHN, Disaster Health Services, American Red Cross, Foley, MN
Background: In 2010 FEMA released guidance for meeting access and functional needs of clients in congregate care disaster shelters. Screening clients as they arrive in disaster shelters using a medical triage style system has shown that clients' functional support needs are often missed. This study sought to improve the screening instrument currently in use, and to tie identified access and functional needs to a staffing support/need prediction. Method: In 2011 in four disaster shelters,access and functional needs-focused client screening instruments were trialed. Assessment was done ‘by family' with 107 adults interviewed representing 233 individuals. Clients were interviewed three or more days post arrival to the shelter. Local census data of persons with disabilities was used to compare the percent of persons “predictable” as having functional support needs in shelters with the actual percent found in the shelters as result of the population assessment. Results: In no shelters was it possible to tie identified needs to published criteria for predicting staffing. In three of four shelters, data showed twice as many persons in the shelter needed functional support than was predicted by county census. Client needs were met through continuous presence of nurses who made rounds to supplement client-directed requests of assistance. Conclusion: Shelter clients are not always able to identify the range of their support needs on arrival. The ideal strategy for identifying and addressing access and functional needs is for shelter health care system to implement a Cot-to-Cot assessment strategy initially and repeat at least 72-96 hours later.

Learning Areas:

Public health or related nursing
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Identify three different access and/or functional categories of client needs in a congregate care disaster shelter setting. Compare a public health community assessment philosophy to a diagnosis-based philosophy for indentifying support needs in a shelter. Explain the cot-to-cot strategy for maintaining client health in a congregate care shelter.

Keyword(s): Disasters, Vulnerable Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I did the original study as a doctoral student, using a mixed-method strategy to identfy a process to meet client needs in disaster shelters. I have been in multiple large scale disasters in response, research and leadership roles. I am a subject matter expert with the American Red Cross for meeting access and functional needs in disaster and consult with FEMA and HHS on care for vulnerable populations in disaster shelters.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.