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Evac - Health Consideration
Evac - Health Consideration
Evac - Health Consideration
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Director-General
GUIDELINE SUMMARY
KEY PRINCIPLES
The impact of some emergencies may exceed the capability of existing evacuation
centre arrangements. The number of people presenting at the centre, the size of the
facility required and the length of time it will need to operate may instigate the
establishment of a major evacuation centre.
Planning for a major evacuation centre needs to address many public health concerns.
These include the physical amenities and space required for well-being, minimising the
risk of communicable disease outbreaks and the need to promote the health of
evacuees to prevent the acute exacerbation of chronic diseases.
The State Emergency Operations Controller is ultimately responsible for the activation
of a major evacuation centre in the event that local resources are not equipped to
manage the accommodation requirements following a decision to evacuate a
population. Activation of a major evacuation centre will require multi-agency
consultation and response.
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REVISION HISTORY
Version
August 2011
(GL2011_011)
Approved by
Deputy Director-General
Population Health and Chief
Health Officer
Amendment notes
New guideline.
ATTACHMENTS
1. Major Evacuation Centres: Public Health Considerations
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Guideline
CONTENTS
1. Introduction ............................................................................................................. 1
1.1 Who uses emergency centres? ........................................................................... 2
2. Health information systems.................................................................................... 2
2.1 The importance of disaster victim registration (DVR) ........................................... 2
2.2 Health surveillance .............................................................................................. 2
3. Physical amenities .................................................................................................. 3
3.1 Location ............................................................................................................... 3
3.2 Areas required ..................................................................................................... 3
3.3 Physical space and air circulation ........................................................................ 4
3.4 Safety, privacy, rights and responsibilities ........................................................... 4
3.5 Water requirements ............................................................................................. 5
3.6 Personal hygiene ................................................................................................. 6
3.7 Mud/disinfecting area .......................................................................................... 6
3.8 Toilets.................................................................................................................. 6
3.9 Cleaning of living areas ....................................................................................... 7
3.10 Recreation area ................................................................................................. 7
3.11 Smoking ............................................................................................................ 8
3.12 Laundry (where available) ................................................................................. 8
3.13 Garbage (solid waste management) .................................................................. 8
4. Food safety .............................................................................................................. 9
4.1 Eating areas and kitchen hygiene ........................................................................ 9
4.2 Serving food ........................................................................................................ 9
4.3 People with special dietary needs and allergies...................................................10
5. Pets and public health .......................................................................................... 10
6. Control of communicable diseases ..................................................................... 12
6.1 Vaccinations ...................................................................................................... 12
6.2 General infection control for evacuation centres ................................................ 13
6.3 Management of people with infectious diseases in evacuation centres.............. 13
6.4 Standard Precautions (summary): ..................................................................... 14
6.5 Sick bays/special temporary accommodation centres ...................................... 15
6.6 Outbreak control ................................................................................................ 15
7. Control of non-communicable diseases/chronic illness management ............. 16
7.1 Injury ................................................................................................................. 16
7.2 Chronic diseases ............................................................................................... 16
7.3 Reproductive health........................................................................................... 16
8. Hygiene promotion................................................................................................ 17
8.1 Hand hygiene .................................................................................................... 17
9. Returning home information ................................................................................ 17
10. APPENDICIES ...................................................................................................... 18
Appendix one - Hand hygiene ................................................................................ 18
Appendix two - Sample health promotion materials ................................................. 19
Appendix three - Environmental health assessment form for centres ...................... 29
Appendix four - References .................................................................................... 31
Appendix five - Additional resources..........................................................................32
GL2011_011
Contents page
1. Introduction
Planning for a major evacuation centre needs to address many public health concerns.
These include the physical amenities and space required for well-being, minimising of
the risk of communicable disease outbreaks and the need to promote the health of
evacuees to prevent the acute exacerbation of chronic diseases.
The NSW State Disaster Plan (Displan) details emergency preparedness, response
and recovery arrangements for New South Wales to ensure the coordinated response
to emergencies by all agencies which have responsibilities and functions in
emergencies.
In addition to the Displan, there are sub plans, which address specific hazards and
supporting plans, which outline arrangements for agencies which may act in a
supporting role. These plans are available at
http://emergency.nsw.gov.au/content.php/475.html .
The State Emergency Operations Controller is ultimately responsible for the activation
of a major evacuation centre in the event that local resources are not equipped to
manage the accommodation requirements following a decision to evacuate a
population. Activation of a major evacuation centre will require multi agency
consultation and response.
This document provides guidance regarding public health matters that may need to be
considered in the establishment and monitoring of a major evacuation centre. It will not
consider provision of medical or mental health services, although these too will have a
significant impact on the health of the evacuee population.
This guideline should not be seen as a stringent set of rules to be applied without the
expert input and discretion of the managing professionals. In any emergency situation
there may be factors which cannot be covered by a single set of guidelines, therefore,
this document should be used as a guide, rather than a mandatory directive to be
followed. It does not replace the need for the application of expert judgement to each
individual situation.
Resources on the practical aspects of planning for a major evacuation centre are listed
in appendix five. Useful guidance is available from the Sphere Projects Humanitarian
Charter and Minimum Standards in Disaster Response i, as adopted by the World
Health Organisation, from Emergency Management Australia ii, from Emergency
Preparedness Canada iii and also from the United States Centres for Disease Control
and Prevention resources iv.
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The HIS should include a component to ensure the timely detection of and response
to infectious disease outbreaks.
Supplementary data from other relevant sources (e.g. police, welfare services) may
be used to assist in the interpretation of surveillance data and to guide decision
making.
3. Physical amenities
Selection of an evacuation centre site and management of the centre is the
responsibility of other agencies. The information below provides guidance for public
health services if they are asked to provide advice as to the adequacy of planned
facilities.
3.1 Location
Where possible and safe, evacuees should be accommodated near to their homes.
If the nature of the emergency is such that the evacuation site is likely to be affected
(e.g. power, water and/or sanitation failures) then it is preferable to move people to a
site of safety.
Any building should be structurally sound and have sufficient fire and emergency
exits. Ensure that gas, electricity, water and sewerage systems have been checked
by the relevant authorities.
The facility will likely be caring for those with limited physical mobility including
those in wheelchairs, those using mobility aids and those with very young children in
prams. This should be considered when planning an evacuation site.
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Reference: The Sphere Project (2011) Humanitarian Charter and Minimum Standards in Disaster
Response.
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3.8 Toilets
Ideally there should be a maximum of 20 people for each available toilet. In the
initial phases of the emergency a figure of 50 people per toilet may be used until
additional facilities are available. Use of toilets could be arranged by households
and/or segregated by sex. The allocation of toilets may depend on the
demographics of the evacuees (e.g. predominantly male vs. predominantly female).
A regular cleaning roster should be established and maintained. Toilet facilities
should include provision for the disposal of womens sanitary products (e.g. bins with
tight fitting lids).
Toilets should be sited in such a way as to minimise threats to users (particularly
children and females). This includes appropriate lighting, or provision of torches to
those in the evacuation centre.
There should be one wash basin per 10 people. Soap, water and hand towels
should be available in the toilets for hand washing. Posters promoting hand washing
should be available in the toilet block.
Refuse bins with tight fitting lids should be located in the toilet block.
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Facilities for changing infants and for the safe disposal of childrens used nappies
should be established, including hand washing facilities next to the changing
station/s.
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3.11 Smoking
There is no legal obligation to provide designated smoking areas. However, if it is
decided such areas are to be provided they should be:
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Garbage should be placed in an area separated from the living spaces, preferably in
garbage bins. Garbage bins should have tight fitting lids to discourage vermin.
Waste pick-ups should be frequently scheduled - daily, if possible. If daily pick-ups
are not occurring, ensure the garbage is stored in a shady location in secure bins.
There should be at least one 100L bin per 40 people. The bin should have a tight
fitting lid and be changed every 2 days.
There should be 2.5 garbage collectors for litter control per 1000 residents.
4. Food safety
4.1 Eating areas and kitchen hygiene
Food should not be consumed in sleeping areas. When people bring their own hot
food into the evacuation centre they should be encouraged to consume it entirely or
to throw out the left-overs. The eating area should be swept after each use and
washed daily.
If a kitchen is accessible, and is being used, some kitchen hygiene rules apply:
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Further information regarding the serving and storage of food are available in the
publication Safe Food Australia, published by the Food Standards Australia and New
Zealand (FSANZ). The NSW Food Authority, part of the Agricultural Services
Functional Area has resources available on-line that may be helpful at
http://www.foodauthority.nsw.gov.au/ .
dogs and cats should be treated for intestinal parasites while staying at the
human centre. This is particularly important when the pet is younger than 6
months old.
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dogs and cats should be treated with medications to kill fleas and ticks. Care
should be taken to administer treatments that are safe for that particular
species of animal (i.e. not all treatments that are safe for dogs are safe for
cats).
furred or feathered pets should be housed in areas separate from people with
allergies or asthma triggered by fur, feathers, or dander.
cats should be kept in a cage with a litter box that is cleaned frequently (at
least once every 24 hours). Pregnant women or immunocompromised people
should not have contact with used litter.
dogs should be walked regularly on a leash outside the centre to allow them
to urinate and defecate in designated areas. Any faeces should be
immediately collected and disposed of.
people caring for pets in evacuation centres should practice good hygiene by
cleaning up after their pets (e.g. disposal of faeces) and frequently washing
their hands.
children younger than 5 years old should not handle reptiles without adult
supervision, and should always wash their hands after doing so. Hand
washing should be monitored by an adult.
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6.1 Vaccinations
The organisation of a vaccination campaign requires good management ability and
technical knowledge. Responsibilities for each component of the vaccination
program need to be explicitly assigned to agencies and persons by the health
coordination agency. NSW Public Health Units are experienced in setting up
vaccination clinics and managing the need for vaccination.
There is no predefined list of vaccines for any single emergency and vaccination
programs should consider each person individually, in the context of the presenting
situation. Routine vaccines should be considered first. If possible, all evacuees
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covering coughs with tissues, disposing of tissues in the garbage after one
use
washing hands or using alcohol-based hand cleanser after coughing, after
going to the toilet and before eating
providing tissues and rubbish bins in evacuation centre living areas.
preparing food hygienically.
not sharing eating utensils or drinking containers
not sharing personal care items such as combs, razors, toothbrushes, or
towels
having sharps disposal containers available.
fever
cough (new or changed)
vomiting
diarrhoea
rash.
People with any of the above conditions should be admitted to the evacuation centre
only after appropriate medical evaluation and care. Evacuation centre staff should
be actively and regularly asking residents of the centre about the presence of above
syndromes in order to identify illness. Residents of the centre should be instructed
to report any of the above conditions to the centre staff, who should consult health
authorities in a timely fashion.
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Evacuation centre staff with any of the above symptoms should not work in the
centre, but should seek medical evaluation by their own GP where available for
assessment and clearance prior to returning to work.
If a communicable disease is identified in a person already residing at the centre, the
ill individual(s) should be separated from other residents or transferred to a special
accommodation centre or sick bay (see section 6.5). A separate area or room to
house potentially infectious people should be identified in advance. If several people
with similar symptoms are identified, they may be housed together in one area.
However, beds should be separated by at least 2m and preferably screened. A
dedicated toilet facility should be identified and reserved for use of the ill individuals
only.
More than one separate area may be needed if more than one illness is identified in
the population, for example, an area for people with diarrhoea and another area for
people with a cough and fever. Such separate areas will need to have extra health
staff dedicated to monitoring people housed there and ensuring that the area is kept
clean and appropriately supplied.
Each evacuation centre should have a clear plan for transferring individuals with
potentially infectious diseases from the centre to an appropriate sick bay, either
within the centre or nearby. The sick bay should ideally be a room where the sick
person can be isolated. Ill individuals with respiratory symptoms should wear a
surgical mask if in close proximity to others while awaiting evaluation or transfer. A
waiting area should be designated that is separate from the main centre living areas,
but which can be closely monitored by centre staff. A system for identifying and
notifying the receiving sick bay must be in place.
Centre staff working with people who have symptoms of illness should use Standard
Precautions (defined in section 6.4) for any interactions that require potential
contact with body fluids, and should place particular emphasis on hand hygiene.
The use of Standard Precautions aims to protect residents and staff from exposure
to recognised and unrecognised sources of infection.
wear gloves if hand contact with blood, body fluids, respiratory secretions
or potentially contaminated surfaces is expected
wear a disposable gown if clothes might become soiled with a patients
blood, body fluids or respiratory secretions
change gloves and gowns after each patient encounter and wash hands or
use alcohol-based hand cleanser immediately after removing gloves
wash hands or use alcohol-based hand cleanser before and after touching
a patient, after touching the patients environment, or after touching the
patients respiratory secretions, whether or not gloves are worn
when hands are visibly dirty or contaminated with respiratory secretions,
wash hands with soap (either plain or antimicrobial) and water
cover any cuts or sores prior to patient care
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6.5
wear a mask and protective eye wear if there is a risk of splash of bodily
fluids.
There will be circumstances where a person becomes unwell and does not require
hospital-level care, but does require a separate room because of the nature of the
disease or because of the potential to infect others. Public health services should be
prepared to make recommendations for the appropriate placement of affected
people, noting that people in this situation only need the level of care that family or
friends would usually provide.
It is strongly recommended that such facilities are planned for and that centre staff,
some with health care experience (e.g. registered nurses) who are willing to care for
sick people are identified.
A clear referral pathway to hospital care (if required) and for reporting disease
outbreaks should be made available during the accommodation planning.
Provision should be made to accommodate at least up to 2% of people in this
fashion. This is an estimate based on the prevalence of infectious diseases during
the winter period in the population. However, in a closed environment the
prevalence is likely to be higher and greater space may be required should an
outbreak occur.
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Injury
The HIS should identify any injuries related to the evacuation centre and injury
prevention programs implemented to minimise the risk of injury in evacuees.
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8. Hygiene promotion
A hygiene promotion campaign should be established within the centre. This is
something that should be included in the evacuee induction.
adequate prescription medication supply and storage facility (e.g. insulin and
refrigeration)
specific medical equipment (e.g. blood glucose monitor, oxygen cylinders,
bandages)
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10. APPENDICES
Appendix one - Hand hygiene
It is best to perform handwashing with soap and running water but, when water isnt readily available,
you can use alcohol-based hand cleanser made for cleaning hands. Below are some tips for washing
your hands with soap and water and with alcohol-based hand cleanser.
When should you wash your hands or use an alcohol hand gel?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
*Food handlers should wash hands with soap and water before beginning work, and before returning
to work from any toilet visit or break. Alcohol-based hand cleanser should not be substituted for food
handlers.
Note: NSW Health has a range of posters and factsheets regarding handwashing, infection control
and cough etiquette available for downloading and printing on the website
www.health.nsw.gov.au
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Children with symptoms of contagious diseases, such as vomiting, diarrhoea, fever, cough, draining skin
sores, rash should not be allowed in common play areas until they are no longer considered infectious, as per
medical advice.
Children and parents should wash their hands with soap and water or clean their hands with antiseptic hand
gel before entering and when leaving the common play area.
Toys used in play areas should be made of smooth solid surfaces that can be easily cleaned and disinfected.
Avoid toys with small pieces and crevices and those made of fabric fur.
Donations of stuffed animals or other toys that cannot be cleaned and disinfected should be accepted only if
they are new and then should be distributed to individual children to keep and not kept in common play areas
to be shared.
Toys should be cleaned and disinfected at least three times a day. In addition, they should be cleaned
immediately if they are soiled with vomit, stool, or other body fluids.
Spray the toys with disinfectant and allow the disinfectant to remain in contact with the toy for one minute, then
wipe off.
Toys that are likely to be mouthed by infants and toddlers should be rinsed with clean tap water after they are
disinfected.
These simple precautions can keep
our guests from getting infections.
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Making food
Touching a sick person
Touching a cut, sore or wound
After
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Fact Sheet
Recommendations for Persons Undergoing Blood Glucose Monitoring in Evacuation Centres for the Prevention of
Hepatitis B Virus, Hepatitis C Virus and Human Immunodeficiency Virus Transmission
Regular monitoring of blood glucose levels through the use of fingerstick devices and portable glucose meters is an
important component of routine diabetes care. Adherence to Standard Precautions, as well as specific infection control
recommendations targeting diabetic care procedures in group residence settings is needed to prevent the transmission of
hepatitis B virus, hepatitis C virus, and human immunodeficiency virus.
The following recommendations can prevent diabetics and other evacuation centre residents from acquiring infections with
bloodborne pathogens.
Diabetes Care Procedures and Techniques
Prepare medications such as insulin in a centralised medication area; multiple-dose insulin vials should be
assigned to individual residents and labelled appropriately
Never reuse needles, syringes or lancets
Ensure a separate fingerstick blood sampling device is available for each affected resident. Consider selecting
single-use lancets that permanently retract upon puncture
Dispose of used fingerstick devices and lancets at the point of use in an approved sharps container
Environmental surfaces such as glucose meters should be decontaminated regularly and any time that
contamination with blood or body fluids occurs or is suspected
Ideally a separate glucose monitoring device should be assigned to each individual resident with insulindependent diabetes. If a glucose meter that has been used for one resident must be reused for another resident,
the device must be cleaned and disinfected with 1:10 dilution household bleach and clean water
Do not carry supplies and medications in pockets
Because of possible inadvertent contamination, unused supplies and medications taken to a residents bedside
during fingerstick monitoring or insulin administration should not be used for another resident.
Wear gloves during fingerstick glucose monitoring, administration of insulin, and during any other procedure that
involves potential exposure to blood or body fluids
Change gloves between resident contacts. Change gloves that have touched potentially blood-contaminated
objects or fingerstick wounds before touching clean surfaces
Remove and discard gloves in appropriate receptacles after every procedure that involves potential exposure to
blood or body fluids, including fingerstick blood sampling
Perform hand hygiene (i.e. hand washing with soap and water or use an alcohol-based hand cleanser)
immediately after removal of gloves and before touching other medical supplies intended for use on other
residents.
Other Considerations
Review regularly the individual residents schedules for fingerstick blood glucose sampling and insulin
administration and reduce the number of percutaneous procedures to the minimum necessary for appropriate
medical management of diabetes and its complications
Assure that adequate staffing levels are maintained to perform all scheduled diabetes care procedures, including
fingerstick blood glucose monitoring
Consider the diagnosis of acute viral hepatitis infection in residents who develop an illness that includes hepatic
dysfunction or elevated aminotransaminase levels (AST or ALT).
Recommendations from the US Center for Disease Control and Prevention. If more information is required, please
see http://www.cdc.gov/ncidod/diseases/hepatitis/mmwr.htm#diabetes .
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2Assessor Name/Title
3Phone:
15State
20Phone
16Zip Code
17Latitude/Longitude
23Current Census _________ 24Estimated Capacity ___________25Number of Residents _________26Number of Staff / Volunteers ________
III. FACILITY
27Structural damage
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Description
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Hanna J (1996). Draft Guidelines for the planning and operation of emergency
reception centres and shelters. Emergency Preparedness Canada, August 1996
iv
Center for Disease Control and Prevention (CDC) (2011). Information for Disaster
Evacuation Centers. Accessed 7 April 2011 online at
http://www.bt.cdc.gov/disasters/evaccenters.asp
v
vii
Cancer Council NSW (2011). Smoking in the workplace. Accessed 7 April 2011 at
http://www.cancercouncil.com.au/editorial.asp?pageid=394
ix
Callaghan W.M. et al. (2007). Health concerns of women and infants in times of
natural disasters: Lessons learned from Hurricane Katrina. Maternal Child Health
J.11(4):307-311
x
Centre for Disease Control and Prevention (CDC) (2005) Clean up after a natural
disaster. Accessed 13 April 2011 online at
http://www.bt.cdc.gov/disasters/hurricanes/educationalmaterials.asp#cleanup
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