Three Hundred Cots in a Gym: The Public Health Nurse in a General Population Shelter After a Hurricane Evacuation
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Master of Science in Nursing Program, Aspen University
N680: Public Health Nursing
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Month Day, Year
Three Hundred Cots in a Gym: The Public Health Nurse in a General Population Shelter After a Hurricane Evacuation
When a hurricane forces a coastal evacuation, inland counties open shelters in schools, churches and arenas, often within hours. Many evacuees arrive with chronic illnesses, disabilities, medications left behind and young children, and they may stay for days or weeks. Public health nurses are among the first clinical staff in these shelters. This paper follows a composite general population shelter opened in a high school gymnasium in an inland county, which reached 312 residents at its peak, and describes the nurse's work in intake screening, support for people with functional needs, prevention of communicable disease and the transition out of the shelter. It draws on a function-based planning framework, federal guidance on functional needs support in general shelters and the lessons of a large shelter outbreak.
Intake Screening by Function
The first contact most evacuees have with the shelter's health staff is an intake screening. Traditional approaches sorted people by diagnosis or labeled them as having special needs, which tended to send people with disabilities or chronic illness to separate medical shelters even when they did not need medical care. A function-based framework, known by the acronym CMIST, instead asks what support a person needs in five areas: communication, maintaining health, independence, support and safety, and transportation (Kailes & Enders, 2007). A deaf evacuee needs an interpreter, not a hospital bed; a man with diabetes needs insulin, a way to keep it cold and regular meals; an older woman who uses a walker needs a cot near the restroom and a clear path.
At the composite shelter, the nurses adapted the intake form to ask five short questions organized by these areas and to record medications, allergies, oxygen or power needs, and whether any medications were left behind. Of the 312 residents, 71 had at least one functional need, most commonly medication replacement, mobility support or power for a medical device. Only three required transfer to a hospital or medical needs shelter.
Keeping People in the General Shelter
Federal guidance issued in 2010 states that general population shelters must plan to serve people with disabilities and others with access and functional needs, rather than routinely sending them elsewhere, and describes the functional needs support services, such as durable medical equipment, consumable medical supplies, personal assistance services and accessible communication, that shelters should provide (Federal Emergency Management Agency [FEMA], 2010). Keeping families together and keeping people with disabilities among their neighbors is both a legal obligation and better care.
Nurses make this possible in practical ways. At the composite shelter they arranged a cot area near restrooms and power outlets, obtained replacement medications through a pharmacy agreement and the state's emergency prescription assistance, kept insulin in a dedicated refrigerator, requested a sign language interpreter and a bilingual volunteer for the Spanish-speaking families, and coordinated personal care assistance through a home care agency. They also watched for residents whose conditions were worsening, such as an older man whose legs became swollen after two days sleeping in a chair, and arranged a clinic visit before a crisis developed.
Preventing Communicable Disease
Crowded shelters are ideal settings for outbreaks. After Hurricane Katrina, more than 27,000 evacuees were housed in a single complex in Houston, and over 11 days more than 1,000 people were treated for gastroenteritis, which accounted for 17% of clinic visits; norovirus was the only pathogen identified, and intensive measures did not clearly slow the outbreak (Yee et al., 2007). The lesson is that prevention must start at opening, not after the first cases.
At the composite shelter, nurses set up handwashing stations with soap and running water at the entrance and near food service, because alcohol-based sanitizer is less effective against norovirus. They asked residents at intake and each morning about vomiting, diarrhea, fever, cough and rash, established a separate area for residents with symptoms and their families with a dedicated restroom, and worked with the custodial staff to clean restrooms and high-touch surfaces using a product labeled to kill norovirus. They checked that food handlers were well and reported symptom counts daily to the health department. When two children developed vomiting on day four, the family was moved to the symptom area and no further cases followed. Nurses also reviewed vaccination records where available and offered influenza and tetanus vaccines.
Mental Health and Transition
Evacuees often arrive exhausted and uncertain whether they have homes to return to. Nurses offered psychological first aid, listened, gave accurate information about the storm's aftermath and connected residents with crisis counselors. As the shelter began to close after nine days, nurses helped plan each resident's transition: confirming that medications and equipment would go with them, making sure people with functional needs had accessible housing, and linking residents with home health, dialysis centers and primary care in their home or new communities.
Children need particular attention. Shelters disrupt sleep, routines and schooling, and children may be frightened by what they saw during the evacuation. At the composite shelter, nurses worked with the school district to set up a supervised play and homework area in a side classroom and helped parents enroll their children temporarily in local schools, which gave families some order and gave parents time to deal with insurance and housing.
Preparing Before the Next Storm
Shelter nursing works best when prepared in advance. Public health nurses can pre-stock shelter kits with intake forms built on the CMIST areas, maintain agreements with pharmacies, medical equipment suppliers and home care agencies, train volunteers in infection prevention, and include people with disabilities in planning. After each activation, a review should ask whether anyone was sent to a medical shelter who could have stayed, and whether any illness spread that could have been prevented.
Conclusion
In a general population shelter, the public health nurse turns planning principles into daily care: screening by function, keeping people with disabilities among their neighbors with the support federal guidance expects, preventing the spread of norovirus and other infections that crowded shelters invite, and preparing each resident for the move home. The composite shelter's experience shows that these actions are ordinary nursing skills applied to extraordinary conditions, and that their success depends on preparation done before the storm.
References
Federal Emergency Management Agency. (2010). Guidance on planning for integration of functional needs support services in general population shelters. https://www.fema.gov/pdf/about/odic/fnss_guidance.pdf
Kailes, J. I., & Enders, A. (2007). Moving beyond "special needs": A function-based framework for emergency management and planning. Journal of Disability Policy Studies, 17(4), 230-237. https://doi.org/10.1177/10442073070170040601
Yee, E. L., Palacio, H., Atmar, R. L., Shah, U., Kilborn, C., Faul, M., Gavagan, T. E., Feigin, R. D., Versalovic, J., Neill, F. H., Panlilio, A. L., Miller, M., Spahr, J., & Glass, R. I. (2007). Widespread outbreak of norovirus gastroenteritis among evacuees of Hurricane Katrina residing in a large "megashelter" in Houston, Texas: Lessons learned for prevention. Clinical Infectious Diseases, 44(8), 1032-1039. https://doi.org/10.1086/512195
How this N 680 Module 5 example is structured
Aspen does not publish N680 module prompts, so check your classroom for the exact instructions. This example sets a concrete shelter scene, then covers intake screening by function, functional needs support in the general shelter, communicable disease prevention, mental health and transition, and preparation for the next event.
N680 Module 5 questions, answered
What does N680 Module 5 usually ask for?
Aspen's N680 description includes the impact of disasters on health, so a paper on disaster preparedness and response and the public health nurse's role is a typical assignment. Check your classroom for the prompt.
What is the CMIST framework?
A function-based approach to planning for people with access and functional needs, covering communication, maintaining health, independence, support and safety, and transportation, instead of sorting people by diagnosis.
Why is norovirus a concern in shelters?
It spreads easily in crowded settings through contaminated hands, surfaces and food, and alcohol-based sanitizer is less effective against it than handwashing with soap and water.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.