Sandra C. Hazlett
Social & Rehabilitation Services
Docking State Office Buielding
915 SW Harrison Street, 6^th Floor N
Topeka, KS 66612

Table of Contents                                             Page

Overview of Emergency Support Function (ESF) 6... 3

Individuals with Functional Needs................................. 3

Responsibilities of Emergency Managers................... 4

Shelter Considerations..................................................... 5

Supportive Care in Functional Needs Shelters.......... 6

Staffing Level Guidelines.................................................. 7

Responsibilities of Functional Needs Shelter Staff... 9

Shelter Support Volunteers........................................... 11

Activation of Functional Needs Shelters.................... 13

After Action Review.......................................................... 17

Attachments................................................................. 18-44

Attachment 1 – Functional Needs Shelter Volunteer Application
Attachment 2 – ARC Shelter Facility Survey
Attachment 3 – Sheltering Space and Floor Plan Considerations
Attachment 4 – Functional Needs Shelter Staff Registration
Attachment 5 – Individual with Functional Needs Registration
Attachment 6 – Interior Signs
Attachment 7 – ARC Intake Form
Attachment 8 – Suggested Supply List for Functional Needs Shelters
Attachment 9 – Functional Needs Shelter Operation Situational Report

Overview of Emergency Support Function (ESF) 6: Mass Care, Sheltering and Human Services

Each ESF in the Kansas Response Plan is headed by a primary state agency which has been selected based on its authorities, resources and capabilities in that functional area. SRS is the primary and coordinating agency for ESF 6: Mass Care, Sheltering and Human Services. As a part of its responsibilities, SRS has a role in helping Emergency Managers plan and provide for the safety of every person in the community, including individuals in the community with functional needs requiring special assistance, and populations considered vulnerable or at risk.

How to address the transportation, shelter, and unique support needs of individuals with functional needs should be addressed by the Emergency Managers, of each county or region in the State, in their Emergency Operations Plan (EOP). SRS Regional Staff can assist Emergency Managers in knowing the distinct populations within their regions for which to plan and for identifying resources in the area that can assist functional needs populations during an emergency.

As long as individuals with functional needs have family or staff who can accompany them and meet their needs, their functional needs can be accommodated in a general needs shelter, per the American Red Cross (ARC) Mass Care guidelines. If individuals with functional needs do not have a support person or caregiver who can accompany them, in the course of developing their EOP, Local Emergency Managers should make arrangements to provide this necessary support, preferably within the ARC general population shelter, or in an alternative location if necessary. The Emergency Manager may seek assistance from SRS staff and staff from other community agencies to provide the support and care giving needed by someone with functional needs in a shelter who is not accompanied by a care giver.

Individuals with Functional Needs

Individuals with functional needs have needs that extend beyond those of the general population and cannot make their own provisions to have their needs met during a disaster. Examples of populations whose members may have functional needs that require assistance during a disaster include those who have:

• Mobility impairments
• Visual impairments
• Hearing impairments
• Speech impairments
• Cognitive impairments
• Chronic medical conditions requiring regular medical treatment, usually provided in the home, such as:
  • Foley catheter maintenance
  • Diabetes
  • Medication management
  • Blood pressure monitoring
  • Ostomy care
  • Stable oxygen and nebulizer therapy

Or those who are:

• Elderly
• Unaccompanied children
• From diverse cultures
• Non English speaking or have limited English proficiency
• Technology dependent and living at home
• Without transportation
• Pregnant women and infants

Some individuals may have conditions that require more complex care than can be provided in a Functional Needs Shelter. Arrangements for admission to a hospital or nursing facility are advisable in these situations. Discussions should take place well in advance of a disaster with area hospitals and nursing facilities regarding their capability to accept persons who cannot be admitted to the Functional Needs Shelter.

Types of treatments/conditions not appropriate for a Functional Needs Shelter include:

• Complex sterile dressing changes
• Peritoneal dialysis (home dialysis)
• Ventilator dependent
• IV chemotherapy
• Any person arriving by ambulance

Responsibilities of Emergency Managers

When drafting their emergency plans, Emergency Managers must take into consideration the additional services needed by individuals with functional needs in their community. Having knowledge of where individuals with functional needs reside is critical during an evacuation, but is difficult to maintain. Knowing the organizations within the community that work with functional needs populations, such as Health Departments, Social and Rehabilitation Services (SRS), Mental Health Centers, Community Disability Organizations, and other functional needs advocates can also be very helpful in locating individuals that need special assistance during a disaster.

Local evacuation plans should outline procedures to ensure the availability of sufficient and timely accessible transportation.When possible, Emergency Managers should arrange for volunteers to accompany the individuals being transported. These volunteers should have the skills necessary to meet the needs of the individuals being served. Various types of transportation may be necessary, keeping in mind that some individuals may be in wheelchairs, have limited agility preventing them stepping up into a bus, or be confined to a bed. Wheelchairs or other mobility devices should always accompany the individual to a shelter location. Service animals should also always accompany the individual.

Shelter plans should include prior arrangements with skilled individuals from the community who can assist in meeting the additional needs of special populations.Shelter plans should also outline how to obtain resources such as medical supplies, durable medical equipment, special cots, diapers, formula and baby food. Emergency Managers can draw from community resources such as Local Health Departments, SRS, Mental Health Centers, Community Disability Organizations and other functional needs advocates to find skilled volunteers and resources. An example of a Functional needs Shelter Volunteer Application is provided in Attachment 1.

If the Functional Needs Shelter is located at a site different than the ARC general population shelter, the Emergency Manager can use the ARC Shelter Facility Survey and Sheltering Space and Floor Plans Considerations ( Attachments 2 and 3) as a guide when determining a location. The shelter must meet Americans with Disabilities Act (ADA) accessibility requirements for both internal and external building access and utilization; and meet ADA requirements for accommodating individuals with service animals.

Shelters are generally located in school buildings, churches, or other community buildings that are not equipped as medical care facilities. Some of the facilities may have no source of emergency power generation, while others may have only a limited source. Thus the safety of performing some medical procedures, such as oxygen therapy, Foley catheter maintenance, tube feeding, etc. may be jeopardized by the integrity of the building, equipment and personnel available.

Finding staff to assist individuals with functional needs during a disaster is dependent on volunteerism from community agencies and providers. Volunteer staff who are willing to assist individuals with functional needs should be familiar with the health conditions or other unique needs of the individuals they are assisting. The volunteers also need to be skilled enough to care for persons who may experience an increase in their medical and psychological acuity, or who may become more disoriented or confused due to the disaster. Many times, local hospitals, home health agencies, developmental disability organizations or mental health centers cannot assign staff to the shelters because they must meet their own needs first.Thus , mutual aid agreements with nearby community providers should be considered when planning for Functional Needs Shelter staffing. Should additional volunteers be needed when a Functional Needs Shelter is opened, the Local Emergency Operations Center (LEOC) may re quest additional volunteer resources through K-SERV.

Persons with functional needs do not always bring needed supplies with them and the ability to access supplies from the community during an emergency may be limited. A supply of oxygen is often needed during a disaster and it is a good idea to notify nearby oxygen providers immediately upon opening a Functional Needs Shelter. Some individuals may not be able to lie down on the type of cots available in most shelters and special cots will need to be made available to accommodate their needs. If needed supplies and equipment cannot be located in the community, and all resources have been exhausted, the Emergency Manager should request these items by contacting the State Emergency Operations Center (SEOC) per standard protocols.SEOC staff will attempt to locate what is needed and make it available to the Emergency Manager.

Supportive Care in Functional Needs Shelters

The following basic supportive care will be provided to individuals seeking refuge in a Functional Needs Shelters.

Assessment: Initial assessment determines if placement in Functional Needs Shelter is appropriate. If the individual is to stay in the shelter, a history should be taken to include caregiver abilities, name of physician, major health problems, allergies, and vital signs as baseline and location of placement in facility.

Comfort: Individuals with Functional Needs are instructed to bring their caregiver (who will remain with them) and all of their own supplies. If they do not, the individual needs to be informed that this is a basic setting and that supplies are limited.

Activities of Daily Living (ADLs): The caregiver should assume primary responsibility for assisting the individual to the bathroom, with meals, and care. The Functional Needs Shelter staff is available to provide additional assistance, if needed.

Procedures: Individuals and/or their caregivers must assume responsibility for managing their own medical care and any procedures they have been managing in the home setting. The Functional Needs Shelter nurse will provide supervision and additional assistance only if needed.

Medications: Individuals with Functional Needs or their caregivers must assume responsibility for administering routine medications, as in the home setting. The Functional Needs Shelter nurse may assist the individual if needed or administer medications as per protocol. If a person's supply of medication is completely consumed during the course of a disaster, the on-call physician may prescribe a new supply.

Oxygen: Individuals with Functional Needs or their caregiver must assume responsibility for managing oxygen and equipment. Oxygen supply representatives or respiratory therapist, respiratory technician, EMT or experienced RN or LPN who are present will assist as needed.Those requiring 24-hour oxygen and/or who are electric dependent, should be evaluated for transfer to a skilled health care facility.Individuals utilizing oxygen concentrators are encouraged to bring their equipment with them for use while electrical power is available. Whenever possible, concentrator patients should have battery backup and provide a small tank in case of power failure or switch to portable oxygen tanks for the duration of the shelter period.

Safety: Reasonable care and judgment should be exercised to assure the safety of individuals and staff within a shelter. Universal precautions and body substance isolation precautions must be utilized. Smoking is not allowed.

Each Functional Needs Shelter should be under the supervision of an on-site licensed medical professional, such as a licensed registered nurse, physician, advanced registered nurse practitioner, or physician assistant at all times.

A licensed physician should be available for immediate medical consultation by phone or in person. As soon as possible, but at a minimum of 72 hours of continued shelter operations, and every 24 hours thereafter, the physician should evaluate the persons with functional needs and approve standard nursing protocols for the Functional Needs Shelter staff. The standard nursing protocols should be developed for the shelter at the local level. It is recommended that a psychiatrist be designated on call for medication consultation to the shelter physician.

Experienced caregivers including certified nurse assistants, personal care attendants, nursing aides, home health aides, companions, EMTs, respiratory, physical and occupational therapists, medical or nursing students, and orderlies may assist in providing care under the supervision of a licensed medical professional.

At least one person currently trained in CPR should be within the shelter at all times, and it is recommended to have two persons if possible.

At least one person familiar with the management of oxygen therapy to handle all respiratory problems and adjust and monitor the oxygen, is also recommended. This person could be a respiratory therapist, oxygen company representative, RN, LPN, or respiratory therapy technician.

Physical and occupational therapists may be needed to assist individuals with their routine daily activities and with transfer assistance if the shelter is open for an extended period of time.

A person should be designated as the supply clerk for managing medical supplies, under the supervision of the licensed medical professional.

On-site recruitment of shelter residents from the general population shelter as volunteers to assist with non-specialized tasks in the Functional Needs Shelter is encouraged; however, a designated licensed medical professional shall supervise them at all times.

The staffing pattern should be adjusted based on the actual numbers and needs of individuals with functional needs in the shelter.

Medical/health professionals should only perform those duties consistent with their level of expertise and only according to their professional licensure and shelter protocols.

A sufficient number of Functional Needs Shelter staff should be identified in order to implement realistic staffing guidelines which permit staff rotation out of the shelter. This may be accomplished by obtaining staffing assistance from a volunteer pool or through mutual aid agreements with local health care professionals or neighboring providers. Functional Needs Shelter nursing and staff members should not be scheduled to work for more than 12 consecutive hours in a 24-hour period.

The Functional Needs Shelter Supervisor should establish a command system within the shelter in order to provide organization and maintain order.

The table below summarizes recommended initial health care staffing levels for providing care within Functional Needs Shelters. After an assessment of the specific needs of the particular shelter, these staffing levels may be modified.

Responsibilities of Functional Needs Shelter Volunteers

Licensed Medical Professional Supervisor
The Medical Supervisor provides oversight of the operation of the shelter. Duties include, but are not limited to:

• Functional Needs Shelter opening and closing; and becoming familiar with the building to be used, its facilities, layout and supplies.
• Assessing individuals brought to the Functional Needs Shelter to determine their most appropriate placement and service needs; referring individuals to skilled nursing facilities or hospitals if necessary and working through the physician consultant to procure this placement. This responsibility may be shared with other licensed medical professional volunteers staffing the shelter.
• Supervising the health care delivery services of the nursing staff, ensuring approved protocols are utilized and that medical update forms are completed on all individuals with functional needs.
• Ensuring that all caregivers have appropriate supervision.
• Preparing supply orders for medications and assuring proper utilization of all supplies.
• Monitoring potential for infectious disease transmission.
• Assuring the food preparation (if done on-site), handling, and feeding of all functional needs individuals is appropriate.
• Evaluating Functional Needs Shelter volunteers for signs and symptoms of stress reaction and poor coping.
• Directing request for needed supplies, personnel, equipment, etc. to the LEOC where the request may be forwarded to the SEOC if local resources are not available.
• Providing updates to the LEOC regarding the number of individuals with functional needs in the shelter, the staffing pattern at the Functional Needs Shelter and any significant occurrences. The LEOC will forward the updates to the ESF 6 Coordinator at the SEOC.

(Note: A separate shelter manager and not necessarily the Medical Supervisor may perform some of the above duties.)

Physician Consultant
The physician consultant will help coordinate health/medical services provided in the Functional Needs Shelter. Duties include, but are not limited to:

• Being immediately available in person or by phone when a Functional Needs Shelter is opened to provide consultation to the Medical Supervisor regarding care decisions.
• Evaluating the individuals with functional needs within 72 hours of the shelter opening, and every 24 hours thereafter, approving standard nursing protocols for the Functional Needs Shelter staff.
• Approving all extraordinary medical procedures performed at the Functional Needs Shelter.
• Providing diagnosis and treatment orders for acute illnesses that occur among individuals in the Functional Needs Shelter, when attempts by nursing staff to contact the primary care physician are unsuccessful.
• Making referrals to a healthcare facility when necessary to diagnosis, prescribe or treat an individual with acute medical needs.
• Consulting with the Medical Supervisor regarding care problems and attempt to provide resolution of these problems.

Nursing Staff
The nursing staff delivers appropriate medical services within the Functional Needs Shelter under the supervision of the Licensed Medical Professional Supervisor. Duties include, but are not limited to:

• Supervising and assisting in the administration of medications.
• Assessing the physical condition of individuals on an on-going basis, maintaining their medical update form and advising the Medical Supervisor of any adverse change in their condition.
• Monitoring individuals who are receiving oxygen and making referrals to oxygen/ respiratory therapist if problems occur.
• Delivering care and assistance to individuals as required following approved protocols.
• Maintaining universal precautions and infection control.

Caregivers
The Caregivers may be certified nurse assistants, personal care attendants, nursing aides, home health aides, companions, EMTs, respiratory, physical and occupational therapists, medical or nursing students, and orderlies, significant others, family members, and/or daily companions. Duties include, but are not limited to:

• Working within license or certification, or skills and abilities.
• Following directions of licensed staff person in charge.
• Assisting individuals to get settled in their space and answering questions regarding location of bathroom, etc.
• Assisting individual with mobility impairments in ambulating, toileting, transfers, and personal hygiene.
• Monitoring the individual's condition for changes and immediately reporting changes or particular needs to the nursing staff.
• Asking individuals if assistance is needed with self-administered medications and treatments then informing a licensed nurse if help is needed.
• Assisting in acquiring food and/or feeding as needed.
• Providing diversion activities, conversation, activities, and orientation to time, etc.
• Assisting in keeping area clean and free of trash.
• Maintaining universal precautions and infection control.
• Assisting the nursing staff as required.

Licensed Mental Health Professional
Duties include:

• Watching for signs of agitation, depression, confusion, etc. and responding to alleviate potential problems.
• Assisting caregivers in promoting diversions activities, conversation, and orientation to time, etc.
• Working with individuals who are experiencing mental health problems and guiding the volunteers as to how to be most therapeutic in the situation.
• Reporting problems and potential problems that may need other intervention to the Medical Supervisor.
• Requesting psychiatric or psychological consultation if an individual with functional needs or a shelter staff member exhibits signs of behavior problems or stress.

Interpreter/Signer/Designee to Oversee Bulletin Board
Duties include:

• Helping individuals with hearing or visual impairments and those with limited English proficiency to communicate and understand what is happening.
• K-SERVE and the Volunteer Application provide the opportunity for shelter volunteers to designate languages spoken.

Respiratory Therapist (if available)
Duties include:

• Assisting individuals with oxygen equipment.
• Performing adjustments to oxygen flow rate as prescribed by a physician.

Physical and Occupational Therapists (if available)
Duties include:

• Assisting with transfers assistance.
• Providing physical therapy to individuals who have the need for these services if the shelter is open for an extended period of time.

Midwife (if available)
Duties include:

• Watching for signs of distress etc. for pregnant women or new mothers.
• Assisting with transporting pregnant women to a medical facility, or assisting with deliveries.
• Assisting pregnant women or new mothers and infants with general care as needed.

Shelter Support Volunteers

The following support volunteers will be available through the general population shelter managed by the American Red Cross, whenever a Functional Needs Shelter is co-located with a general population shelter. However, if the Functional Needs Shelter is set up separately, these support staff will be required and may be available through the ARC.

Registrar
Ensures that all shelter occupants, volunteers and family members are registered upon arrival. See Attachments 4 and 5 for example Registration Forms. It is very important to ascertain the names of family or friends as well as home health or other community support agencies involved and to obtain information on how the individual with functional needs arrived.

Maintains a system for checking occupants in and out when they leave for any period of time. Manages the system of record keeping for shelter registration. Provides information services. Must be able to work well with people. Duties include, but are not limited to:

a. Initial Actions

• Setting up the waiting and registration area. Assisting Nurse Manager in Triage Station set up.
• Ensuring that all shelterees are registered before they go into the main part of the shelter.
• Ensuring that orientation information is available to give to the shelterees when they arrive.
• Posting orientation information in areas where it can be read by shelterees and family members.

b. Ongoing Actions

• Supervising Registration Assistants.
• Instituting system for shelterees to be checked in and out.
• Keeping accurate count of number of shelterees in the shelter.
• Maintaining list of all shelterees.
• Providing information to shelterees and family members.
• Recruiting shelterees as volunteers and assigning them to appropriate areas to assist with shelter operations.

c. Closing Actions

• Ensuring a list of all staff and volunteers are prepared so that proper thank you notes can be sent.

Security Personnel
Maintains the security and safety of the volunteers, shelterees and family members arriving at the shelter. Works together with the local law enforcement agency. Duties include, but are not limited to:

a. Initial Actions

• Checking in with the Shelter Manager.
• Posting Exterior Signs guiding traffic to the shelter.
• Establishing one main entranceway for the flow of shelterees into the shelter.
• Working with the Shelter Manager to set up schedule of security.

b. Ongoing Actions

• Directing traffic coming to the shelter.
• Monitoring parking and arrival/departure of shelterees.
• Ensuring that entranceway to shelter remains clear and accessible.
• Directing emergency and supply vehicles to appropriate locations.
• Maintaining order and eases problems that may arise among shelterees.
• Monitoring exits and restricted areas.
• Maintaining the integrity of the building by ensuring it is secure.
• Apprising Shelter Manager of any concerns or problems.
• Assuring the safety of all persons.
• Responding to emergencies at the center as needed.

c. Closing Actions

• Directing traffic for the pick-up of shelterees, volunteers and supplies
• Removing Exterior Signs

Concept of Operation
The decision to activate a Functional Needs Shelter is made by the local emergency management who will contact the designated Licensed Medical Professional Supervisor where the Shelter will open. The Medical Supervisor will notify support agencies and personnel with estimated opening time and location. If additional personnel are needed, the Shelter Manager may contact the LEOC to request that additional volunteer resources be requested through K-SERV. The Shelter Manager will work with the LEOC to have the necessary information available for a proper volunteer request.

Agencies who are contacted will notify their staff and place them on standby for Functional Needs Shelter operations. In addition the agencies will:

• Review their plans and Standard Operating Procedures (SOPs).
• Inspect, dispense and/or relocate available equipment, supplies and other resources.
• Notify the Medical Supervisor of any problems/deficiencies.
• Coordinate staff to report to the Functional Needs Shelter at designated time.

Staff who is expected to report to a Functional Needs Shelter during an activation will implement their personal emergency preparedness plan by:

• Securing their home.
• Making arrangements for family members/pets during their activation.
• Locating their personal supplies that will be needed during the activation.
• Ensuring that they have supplied up to date emergency contact numbers to their agency or the person who will be notifying them.
• Ensuring that any vehicles and/or equipment they will need is operational and that any supplies they may need during the event are on hand.

Opening the Functional Needs Shelter
The designated person responsible for the building and the Medical Supervisor will open the Functional Needs Shelter (whether it is co-located with the ARC general population shelter or at a different location). Once the Functional Needs Shelter is opened, the Medical Supervisor should survey the area, documenting the condition of the area to be utilized for individuals with functional needs and any equipment that will be utilized during the shelter operation.

Exterior signs should be posted in pre-designated areas to guide traffic to the Functional Needs Shelter. Interior signs should be posted to identify the various stations and important locations within the shelter. See Attachment 6 for examples of Interior Signs.

A bulletin board should be located in a public and easily accessible area to post shelter notices, updates on the status of the emergency event, questions and answers, and other important communication. Someone should be designated to oversee the bulletin board and be available to assist individuals with communication difficulties.

A private area marked for breastfeeding or pumping mothers should be located within the shelter.

The registration area should be set up near the main entrance to ensure that all persons coming to the Functional Needs Shelter, and general population shelter if co-located, are screened and registered. The ARC Intake Form (Attachment 7) can be used for all populations. Some individuals with functional needs may need one-on-one assistance in completing the intake form and having a place to assist them away from the main flow of registration traffic will be beneficial.

The assessment of whether an individual has functional needs requiring assistance from Functional Needs Shelter volunteers is completed by a licensed medical professional after they are registered at the Shelter. Health information will be requested and an initial examination may be performed, therefore, privacy should be considered when selecting a location to conduct the assessments. The medical professionals will direct individuals to an area of the shelter based on the level of care that is required.

Volunteers are expected to report to the Functional Needs Shelter under the agreements made by each individual or agency with the Local Emergency Manager. All volunteers reporting to the Functional Needs Shelter must report and sign in at the shelter registration desk. Volunteers should then report to the Medical Supervisor. Volunteers should be issued and wear Functional Needs Shelter identification, if available. All volunteers should log the hours they work while the shelter is open. This information will be needed by the emergency manager following the event.

A location within the shelter should be designated as the nurse's station. It should include a first aid station and medical supply area. A medical professional should staff the nurse's station and the medical supply area should be secured. All pre-identified medical supplies will be delivered to the nurse's station and should be logged when received. See Attachment 8 for a list of recommended supplies. Upon receipt of medical supplies, the Medical Supervisor or designee will verify items and quantities, noting any discrepancies on the inventory sheets. An inventory control sheet should be maintained for recording any supplies used.

A temporary morgue needs to be established in case of a death in the Functional Needs Shelter or general population shelter. The morgue area should be an isolated room, away from the general congregation areas. The deceased person should be shrouded with a blanket and have an identification band applied to the wrist and ankle, if possible. If no family member is available to take possession of personal belongings, the items should be inventoried and stored in a secure area. The Medical Supervisor should notify the LEOC, who in turn will notify the medical examiner, next of kin and SEOC ESF 8 Coordinator. The body should not be removed until released by law enforcement.

A volunteer sleeping area should be located in a quiet area of the shelter, preferably away from the main traffic. The area should be secure from outside entry for volunteer safety and lockable from the inside. The ideal area would be an area where there is limited or no natural light to allow for people to sleep during the day.

Functional Needs Shelter Operations

As volunteers leave the shelter after their shift and are replaced by someone new, they should brief individuals relieving them before departing the shelter. The Medical Supervisor should be notified upon departure.

Individuals with functional needs may leave the shelter at will, except during the height of a disaster when opening doors may jeopardize the safety of the volunteers and other individuals with functional needs. As individuals come and go from the shelter they should check in at the registration desk.

It is the responsibility of the Medical Supervisor to determine who should receive specialized cots and other supplies. These items may be limited in number and should be assigned to those who have the greatest need.

It is probable that a Functional Needs Shelter will be visited by the media or by other people who are not there to stay or to assist. All visitors must sign in at the registration area and state their purpose. The Medical Supervisor should be notified of all visitors to the Functional Needs Shelter. Visitors should be asked to wait in an area that does not interfere with Functional Needs Shelter operations. They should be treated in a kind and courteous manner and asked to wait for the Medical Supervisor. The LEOC should be notified when the media arrive. Solicitation of any nature is prohibited. Media filming and photographing of individuals and facilities is not allowed without approval and individual consent.

The feeding responsibilities in a Functional Needs Shelter include supervising on-site food preparation (if applicable), distribution and feeding to insure appropriate diets are maintained and food is being handled properly. The local emergency manager will work collaboratively with the ARC, Salvation Army, or other local resources to secure a food source if preparation is not taking place on-site. The Medical Supervisor should advise the LEOC of any special supplies that are needed.& The LECO can request assistance in finding supplies from the SEOC.

It is the responsibility of the Medical Supervisor to keep the LEOC apprised of the events in the Functional Needs Shelter. Attachment 9 is an example of a Situational Report form. It is the responsibility of the LEOC to keep the SEOC informed. The following items should be reported:

• Volunteer Shortages: Volunteer shortages should be reported to the LEOC. If additional local or mutual aid resources cannot be identified, the SEOC should be notified.
• Supply Shortages:Supply shortages should be reported to the LEOC which will attempt to secure the supplies needed. Only essential supplies should be requested. If additional supplies cannot be located locally or via mutual aid, the SEOC should be contacted.
• Number of Individuals with Functional Needs in the Shelter: Each Functional Needs Shelter must report the number of occupants to the LEOC on a daily basis at a minimum. This information needs to be updated on the National Shelter Survey (NSS). When shelter reaches 80% capacity, every attempt will be made to start rerouting traffic to other Functional Needs Shelters, if there is an alternate. Agencies providing food and other resources must be provided daily census updates.
• Problems: Any problems arising in the Functional Needs Shelter that requires assistance should be reported to the LEOC.

The Medical Supervisor should also provide updates and announcements to the individuals and volunteers in the Functional Needs Shelter, verbally and by posting information on the bulletin board. The availability of language interpreters and signers will assist with communication.

The decision to close the Functional Needs Shelter rests solely with the local emergency manager. Functional Needs Shelters will be scaled down and perhaps consolidated, as individuals are able to return safely home or to other appropriate living arrangements. In cases where individuals with functional needs are unable to return to their homes, attempts will be made to identify alternate facilities, i.e., with family, friends or other accommodations. At the time the Functional Needs Shelter closing is announced, the Functional Needs Shelter volunteers should determine the number of individuals needing temporary housing.

The decision regarding closure of the Functional Needs Shelter will be based, in part, on the following:

• Impact of the event on persons with functional needs homes or environment (i.e., person's home exists but rest of the neighborhood is gone, power out, etc.).
• The urgency of the need to return the facility to normal conditions.
• Availability of transportation resources.
• Time of day.

Persons with functional needs may be anxious to return to their homes and should be advised to wait for the "all clear" to be given by the local emergency manager.

When it is time for departure, nursing staff and/or other caregivers, will assist individuals with functional needs with the necessary arrangements. Phone calls to public transportation, a home health or community support agency, a family member, etc. may be required. For those who depend upon electricity, contact the LEOC in order to verify an address for a client with functional needs and the availability of power.

If no arrangements can be made to get the client with functional needs home, or if the home is uninhabitable, the Department of Social and Rehabilitative Services may be notified to provide assistance in locating temporary housing. Every effort should be made to insure that individuals are moved back to the least restrictive environment.

Upon departure, the time and date will be recorded on the Individual with Functional Needs Registration (Attachment 5) along with the departure plans (i.e., public transportation, wheelchair assist vehicle, friends, family, ambulance, etc. ; and notification will be provided to the RN Supervisor.

When the Functional Needs Shelter is closed the RN Supervisor or designee will complete a final inventory of the remaining supplies and calculate the total quantity used. The inventory sheets are to be returned to the LEOC.

After the Functional Needs Shelter has closed and the initial post-disaster work has been completed begin the after action review process by:

• Reviewing all of the above activities
• Debrief all individuals involved
• Analyze all registration and charting forms, logs, etc.
• Gathering information and data
• Celebrate accomplishments gained since past disasters
• Identify priorities for improvement
• Provide roadmap for implementation of future training and exercise priorities
• Start making appropriate changes in future preparation plans