Practice in Information Technology Support for Fangcang Shelter Hospital during COVID-19 Epidemic in Wuhan, China.

In confronting the sudden epidemic of COVID-19, China and other countries have been under great deal of pressure to block virus transmission and reduce death cases. Fangcang shelter hospital, which is converted from large-scale public venue, is proposed and proven to be an effective way for administering medical care and social isolation. This paper presents the practice in information technology support for a Fangcang shelter hospital in Wuhan, China. The experiences include the deployment strategy of IT infrastructure, the redesign of function modules in the hospital information system (HIS), equipment maintenance and medical staff training. The deployment strategy and HIS modules have ensured smoothness and efficiency of clinical work. The team established a quick response mechanism and adhered to the principle of nosocomial infection control. Deployment of network and modification of HIS was finished in the 48 hours before patient admittance. A repair hotline and remote support for equipment and software were available whenever medical workers met with any questions. No engineer ever entered the contaminated areas and no one was infected by the coronavirus during the hospital operation. Up to now, Fangcang shelter hospital is adopted by many regions around the world facing the collapse of their medical systems. This valuable experience in informatization construction and service in Wuhan may help participators involving in Fangcang shelter hospital get better information technology support, and find more practical interventions to fight the epidemic.

[Measures to contain gender-based violence during the COVID-19 pandemic]. / Medidas de contención de la violencia de género durante la pandemia de COVID-19.

Crises, emergencies and times of unrest have been linked to increased interpersonal violence, including violence against women. Following the declaration of alarm status and quarantine, different measures have been implemented to mitigate the possible effect of gender violence (Contingency Plan against Gender-Based Violence in Coronavirus Crisis or Royal Decree Law on Emergency Measures). This document reviews the measures adopted so far by the government of Spain, the autonomous governments and the initiatives formulated in different countries. In the absence of concrete economic measures to date, and the scenario of economic uncertainty, we conclude that it is not possible to prevent gender-based violence in a comprehensive way, without considering the increase in unemployment, temporary and instability employment, economic dependency or the overload of household chores and reproductive tasks, among other elements that facilitate it.

Comparison of Two Evacuation Shelter Operating Policies and the Role of Public Health Nurses after the Great East Japan Earthquake: A Qualitative Study.

This study describes shelter operations by public health nurses (PHNs) in Kesennuma City, located near the epicenter of the Great East Japan Earthquake, which occurred on March 11, 2011. The data were semi-structured interviews with 10 PHNs, 2 nutritionists, and 2 general administrators conducted from July 2013 to January 2014. All transcripts were analyzed using the constructivist grounded theory approach. We identified two operating methods for shelters: shelters stationed by PHNs in the Old City, and shelters patrolled by PHNs in the merged district. These methods were compared using four themes. In emergency situations, "operational periods," a predetermined short term for a leader to perform his/her duties responsibly, could be adopted for relatively small organizations on the frontline. PHNs must not only attempt to operate shelters on their own but also encourage residents to manage the shelters as well. Moreover, human resource allocation should be managed independently of personal factors, as strong relationships between shelter residents would sometimes disturb the flexibility of the response. Even when a situation requires PHNs to stay in shelters, frequent collecting of information and updating the plan according to response progress will help to maintain effective shelter operations.

Protocols for Personal Protective Equipment in a COVID-19 Medical Shelter.

The coronavirus disease 2019 (COVID-19) has greatly impacted health-care systems worldwide, leading to an unprecedented rise in demand for health-care resources. In anticipation of an acute strain on established medical facilities in Dallas, Texas, federal officials worked in conjunction with local medical personnel to convert a convention center into a Federal Medical Station capable of caring for patients affected by COVID-19. A 200,000 square foot event space was designated as a direct patient care area, with surrounding spaces repurposed to house ancillary services. Given the highly transmissible nature of the novel coronavirus, the donning and doffing of personal protective equipment (PPE) was of particular importance for personnel staffing the facility. Furthermore, nationwide shortages in the availability of PPE necessitated the reuse of certain protective materials. This article seeks to delineate the procedures implemented regarding PPE in the setting of a COVID-19 disaster response shelter, including workspace flow, donning and doffing procedures, PPE conservation, and exposure event protocols.

Consideraciones para el uso de hoteles durante la pandemia de la COVID-19 / Considerations for Hotel Use During the COVID-19 Pandemic

Describe, argumenta y detalla el uso de los hoteles como una ampliación de las capacidades de respuesta en el nivel primario de atención hospitalaria, citando al menos dos casos internacionales en los que se recurrió a los mismos para paliar la necesidad de espacios para enfermos leves y/o asintomáticos. El objetivo del documento es proporcionar orientaciones técnicas a los hospitales públicos, privados y del seguro social que determinen como estrategia de expansión de servicios de salud de primer nivel, la contratación de hoteles para la atención de pacientes con COVID-19 leves y asintomáticos a fin de liberar espacio físico y sobre todo capacidad de atención especializada en un escenario de crisis. Incluye además alguna argumentación jurídica así como el detalle de las condiciones que deben ser llenadas por los hoteles a considerar, así como el trámite que debe realizarse para ello.

Analysis of Flood Evacuation Process in Vulnerable Community with Mutual Aid Mechanism: An Agent-Based Simulation Framework.

Timely and secure evacuation of residents during flood disasters or other emergency events is an important issue in urban community flood risk management, especially in vulnerable communities. An agent-based modeling framework was proposed in order to indicate how the community properties (e.g., community density and percentage of vulnerable residents), residents' psychological attributes (e.g., flood risk tolerance threshold) and mutual aid mechanism affect the flood evacuation process. Results indicated that: (1) The community density negatively affected the flood evacuation efficiency. The greater the density of the community, the longer the evacuation time. (2) There was a negative correlation between the flood risk tolerance threshold of residents and evacuation efficiency. (3) The proportion of vulnerable resident agents had opposite effects on the evacuation efficiency of different types of communities, which was to negatively affect low-density communities and positively affect high-density communities. (4) Mutual aid mechanism can reduce evacuation time in low-density communities, and the effect was more pronounced with a higher proportion of vulnerable resident agents in the community. These findings can help managers to develop better emergency evacuation management for urban communities.

Typhoon track change-based emergency shelter location-allocation model: a case study of Wenchang in Hainan province, China.

BACKGROUND: Determining the locations of disaster emergency shelters and the allocation of impacted residents are key components in shelter planning and emergency management. Various models have been developed to solve this location-allocation problem, but gaps remain regarding the processes of hazards. This study attempts to develop a model based on the change of typhoon track that addresses the location-allocation problem for typhoon emergency shelters. PURPOSE: To consider the changes in candidate shelters and number of evacuees due to the change in impact area with the progression of a typhoon. METHODS: The proposed model is composed of several static processes and solved by a modified particle swarm optimisation algorithm with a restart strategy. RESULTS: The model is illustrated with the case of the evacuation process for Wenchang in Hainan province during Typhoon Rammasun in 2014 and Typhoon Mirinae in 2016. For the case of Typhoon Rammasun in 2014, the residents from east to west need to evacuate in three phases. For the case of Typhoon Mirinae in 2016, residents in the northern communities need not to evacuate to candidate shelters because they are not affected by the typhoon. CONCLUSION: The proposed model has advantages compared with non-typhoon track change-based model in saving time spent in shelters for residents and saving public resources for the local governments. With the proposed model, a manager could efficiently evacuate residents by considering the typhoon conditions.

A Risk-Averse Shelter Location and Evacuation Routing Assignment Problem in an Uncertain Environment.

Disasters such as hurricanes, earthquakes and floods continue to have devastating socioeconomic impacts and endanger millions of lives. Shelters are safe zones that protect victims from possible damage, and evacuation routes are the paths from disaster zones toward shelter areas. To enable the timely evacuation of disaster zones, decisions regarding shelter location and routing assignment (i.e., traffic assignment) should be considered simultaneously. In this work, we propose a risk-averse stochastic programming model with a chance constraint that takes into account the uncertainty in the demand of disaster sites while minimizing the total evacuation time. The total evacuation time reflects the efficacy of emergency management from a system optimal (SO) perspective. A conditional value-at-risk (CVaR) is incorporated into the objective function to account for risk measures in the presence of uncertain post-disaster demand. We resolve the non-linear travel time function of traffic flow by employing a second-order cone programming (SOCP) approach and linearizing the non-linear chance constraints into a new mixed-integer linear programming (MILP) reformulation so that the problem can be directly solved by state-of-the-art optimization solvers. We illustrate the application of our model using two case studies. The first case study is used to demonstrate the difference between a risk-neutral model and our proposed model. An extensive computational study provides practical insight into the proposed modeling approach using another case study concerning the Black Saturday bushfire in Australia.

An Optimization-Based Approach to Social Network Group Decision Making with an Application to Earthquake Shelter-Site Selection.

The social network has emerged as an essential component in group decision making (GDM) problems. Thus, this paper investigates the social network GDM (SNGDM) problem and assumes that decision makers offer their preferences utilizing additive preference relations (also called fuzzy preference relations). An optimization-based approach is devised to generate the weights of decision makers by combining two reliable resources: in-degree centrality indexes and consistency indexes. Based on the obtained weights of decision makers, the individual additive preference relations are aggregated into a collective additive preference relation. Further, the alternatives are ranked from best to worst according to the obtained collective additive preference relation. Moreover, earthquakes have occurred frequently around the world in recent years, causing great loss of life and property. Earthquake shelters offer safety, security, climate protection, and resistance to disease and ill health and are thus vital for disaster-affected people. Selection of a suitable site for locating shelters from potential alternatives is of critical importance, which can be seen as a GDM problem. When selecting a suitable earthquake shelter-site, the social trust relationships among disaster management experts should not be ignored. To this end, the proposed SNGDM model is applied to evaluate and select earthquake shelter-sites to show its effectiveness. In summary, this paper constructs a novel GDM framework by taking the social trust relationship into account, which can provide a scientific basis for public emergency management in the major disasters field.

Hospitals Providing Temporary Emergency Department Services in Alternative Care Settings After Hurricane Sandy.

This article reports findings of a qualitative study describing how the US Department of Veterans Affairs cared for vulnerable veterans after Hurricane Sandy while medical center was closed for an extended period. This experience highlights how vulnerable patients continued to need care. Hospital preparedness planning efforts focus primarily on sheltering in place and evacuation. Research is needed to identify how hospitals provided temporary emergency services in alternative settings to inform practical guidance. Hospital planners should anticipate that their most vulnerable patients will continue to need emergency care. Viable solutions should be considered to meet immediate and long-term patient needs.

Disaster-Related Surveillance Among US Virgin Islands (USVI) Shelters During the Hurricanes Irma and Maria Response.

OBJECTIVES: Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts. METHODS: Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter's health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria. RESULTS: Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%). CONCLUSION: Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43).

Influenza A (H3) Outbreak at a Hurricane Harvey Megashelter in Harris County, Texas: Successes and Challenges in Disease Identification and Control Measure Implementation.

ABSTRACTWhen Hurricane Harvey landed along the Texas coast on August 25, 2017, it caused massive flooding and damage and displaced tens of thousands of residents of Harris County, Texas. Between August 29 and September 23, Harris County, along with community partners, operated a megashelter at NRG Center, which housed 3365 residents at its peak. Harris County Public Health conducted comprehensive public health surveillance and response at NRG, which comprised disease identification through daily medical record reviews, nightly "cot-to-cot" resident health surveys, and epidemiological consultations; messaging and communications; and implementation of control measures including stringent isolation and hygiene practices, vaccinations, and treatment. Despite the lengthy operation at the densely populated shelter, an early seasonal influenza A (H3) outbreak of 20 cases was quickly identified and confined. Influenza outbreaks in large evacuation shelters after a disaster pose a significant threat to populations already experiencing severe stressors. A holistic surveillance and response model, which consists of coordinated partnerships with onsite agencies, in-time epidemiological consultations, predesigned survey tools, trained staff, enhanced isolation and hygiene practices, and sufficient vaccines, is essential for effective disease identification and control. The lessons learned and successes achieved from this outbreak may serve for future disaster response settings. (Disaster Med Public Health Preparedness. 2019;13:97-101).

Women Victims of Intimate Partner Violence in Shelters: Correlates of Length of Stay and Subsequent Reentries.

The purpose of this study was to examine which variables are associated with the length of stay at a shelter and the likelihood of reentering the shelter after a first stay in a sample of 777 women victims of intimate partner violence. The results showed that the women's health, having been previously abused, and having children with them at the shelter were the best set of correlates for length of shelter stay; lack of social support, having been previously abused, and the abusers' being unemployed increased the risk of repeated use of shelters. The implications for intervention are discussed.

Dallas MegaShelter Medical Operations Response to Hurricane Harvey.

On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with "mega-sheltering," beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33-37).

Safeguarding older adults with dementia, depression, and delirium in a temporary disaster shelter.

Natural disasters impact people of every age in the communities where they occur, with older adults being a vulnerable subset of the population. Most disaster shelter volunteer nurses are experienced in addressing common health needs of older adult clients such as diabetes, hypertension, and pulmonary disease. These nurses also have the requisite training to respond to more acute medical events, including the symptoms of a heart attack or stroke. They provide care and comfort to those suffering from the distress, anxiety, and fear caused by disasters. However, they may be less adept at triaging and caring for older adults with mental health conditions such as delirium, depression, or dementia. The trauma associated with a disaster and relocation will challenge cognitive abilities in those with dementia, may exacerbate existing depression, or lead to the onset of delirium, which is a medical emergency. Older adults experiencing these conditions are at risk for harm and deterioration with serious short and long-term consequences. Since disaster shelter volunteer health care staff may not be well-versed in distinguishing between dementia, depression, or delirium, behavior observation, and safety considerations are critical determinants of whether it is possible to support the older adult in the shelter environment or it is necessary to transition to a higher level of care.

The Safe Shelter Collaborative: An Innovative Approach to Locating Emergency Shelter for Human Trafficking and Domestic Violence Survivors.

When your residential program is full, finding emergency shelter for human trafficking and domestic violence survivors can be challenging. Advocates often spend hours calling one agency after another to locate an appropriate placement. The Safe Shelter Collaborative is an innovative technological approach to locating emergency shelter. By sending out a blast alert to certified users within a geographic network, agencies provide faster access for a greater number and diversity of survivors. This article reports on an evaluation of the Safe Shelter Collaborative and the ways it has transformed the process of finding emergency shelter.

Urban Resources Selection and Allocation for Emergency Shelters: In a Multi-Hazard Environment.

This study explores how emergency shelters can adapt to a multi-hazard environment by geographic information system (GIS) and takes Guangzhou as a case for analysis. The physical suitability of the overall urban resources was first assessed by aiming to select the suitable resources and safe locations for emergency shelters in the context of multiple disasters. Afterward, by analyzing the scale and spatial distribution of affected areas and populations under different types of disaster scenarios, the demand for different kinds of shelters were predicted. Lastly, taking into account the coverage of the affected people, shelters were allocated according to different conditions in the districts. This work will hopefully provide a reference for the construction of emergency shelters and help form emergency operations in order to mitigate the impact of hazards. The issues identified in the study need to be further studied in medium or small-scale cities.

["The heart of our mission is to provide emergency shelter, at any time, including weekends"]. / « Le cœur de notre mission est l'accueil d'urgence, à toute heure, y compris les week-ends ¼.

The Abri côtier-Urgence Femmes is an association in Concarneau, Brittany, which helps victims of domestic abuse, by offering them shelter and support, 24/7. A former psychiatric nurse and manager, Edith Rivet volunteers for the association, and shares with us her commitment to the cause.