Example Student Project

Title & Introduction

Health Problem

Learning Objective

Methodology

Interdisciplinary Methods

Implementation Activities & Schedule

Objective outcome measures

tables

References

OBTAINING MEDICAL EQUIPMENT TO MONITOR CHRONIC ILLNESSES DURING DISASTERS IN DUPLIN COUNTY,
NORTH CAROLINA
an Interdisciplinary Community Assistant Project
for the Interdisciplinary Rural Health Training Program at ECU

by Joan Nelson, Physician Assistant Student
December 1, 1999

This project aims to provide medical equipment for use in emergency shelters in Duplin County during natural disasters. Simultaneously, this equipment will be used in peer education teams to educate the community about chronic illnesses and ways to monitor them. All health care providers, no matter their discipline, can be involved in this project, either in providing care in the shelters, identifying patients interested in leading peer education teams, or identifying those in need of education. The head organization would be the Duplin County Health Department, but all health agencies in the county could be involved.

return to top of page

STATEMENT OF HEALTH PROBLEM: The management of chronic illnesses during disasters in Duplin County, North Carolina.

The people of Duplin County, North Carolina are poorer, older, more rural, and are more likely to be minorities than the averages of both North Carolina and the United States. Chronic illnesses, such as hypertension, diabetes mellitus and asthma, become more common with each of these factors. The mortality rates for heart disease and diabetes are also higher in Duplin County than NC and US averages.

During a disaster, such as the recent hurricane Floyd (which struck Duplin County on September 15, 1999), management of, and continuity of care for, chronic illnesses are major problems. There was a 65% increase in the number of ER visits for "medical needs" in Eastern NC counties in the week following Floyd. Included in "medical needs" are: need for oxygen, dialysis, asthma, insulin, and drugs for chronic illnesses.

During hurricane Floyd, Duplin County opened 6 shelters and housed 3480 people (8% of the county's population). Since people with fewer resources are more likely to need emergency shelter, the proportion of people with chronic illnesses was probably higher in the shelter population than Duplin County as a whole.

The shelters were medically staffed by 12 RNs (registered nurses), 2 NPs (nurse practitioners), 0 PAs and 0 MDs. The medical staff was overworked, and undersupplied. To improve medical services in the shelters during future disasters, there are many options to consider: increase the number of providers (possibly by developing a disaster response team among local RNs, NPs, PAs, and MDs); increase the supply of needed drugs (see Adam Ripley's project proposal); and, what this project will focus on, increase the supply of medical equipment.

The need for medical supplies after hurricane Floyd has been recognized at the statewide level. The recently established North Carolina Drug, Medical Supply and Durable Medical Equipment Assistance Program is coordinated through UNC. This program is currently providing needed items to patients with chronic illnesses who have been affected by Floyd. However, there will still be a need for these items in shelters during, and immediately after, the next disaster.

return to top of page

STATEMENT OF LEARNING OBJECTIVE: Obtain medical supplies for use in disaster emergency shelters.

Having simple medical tools available is necessary to monitor chronic health problems. Some examples are: blood pressure cuffs, stethoscopes, peak flow monitors, and glucometers. These tools are also necessary for, or helpful in, assessing acute illnesses that also occur during disaster emergencies.

Instead of obtaining this equipment and having it sit idle until the next disaster emergency, it could be used to simultaneously teach the community (both people with and without chronic illness) the importance of knowing how to use these items.

These items are tools that people with chronic illnesses should know how to use, and if possible, even own. They should be aware that during an emergency they should pack their medical equipment along with their other emergency items such as medicines, important papers, food and clothes.

return to top of page

METHODOLOGY:
Health providers in Duplin County, especially those that worked in the shelters during hurricane Floyd, will be surveyed for what medical equipment is most needed.

Medical supply companies will be approached for donations. As the North Carolina Drug, Medical Supply and Durable Medical Equipment Assistance Program has shown, companies are very willing to donate, especially following a disaster such as Floyd. Money can also be raised, through grassroots means or foundations, to buy needed equipment that is not donated.

Once equipment is obtained, it will be clearly labeled as belonging the the emergency shelter program (possibly both with brightly colored labels and permanent etching). A permanent storage location (probably at the Health Department) will be defined. Equipment will be returned to this location after each use. A schedule for needed maintence will be made (battery checks, etc).

Use of each piece of equipment will be reviewed (or taught) to all health providers which might staff emergency shelters, as well as those that will participate in the community equipment trainings.

Health providers to head up peer education teams will be identified (not just nurses – this could include dieticians, social workers, etc). Community members interested in participating in the teams will be identified (they might be people with chronic illness under good control, ask health providers to help locate motivated individuals).

Formulate plans for recruiting community members in need of education on use of medical equipment (diabetes education classes, cardiac rehab centers, community health centers, pharmacies, etc).

Perform peer education trainings in the community. These can continue over an indefinite period of time. After each time the equipment is used it will be returned to its proper place at the health department, in case a disaster should occur.

Equipment will be replaced as needed.

return to top of page

INTERDISCIPLINARY METHODS:
All health providers can be involved in this project (RNs, FNPs, PAs, MDs, dieticians, SWs, health educators, etc), even if they do not routinely monitor patients with chronic illness, or staff emergency shelters. They can help survey people with chronic illness, identify people as peer team leaders, and and identify community members interested in participating in peer education groups.

return to top of page

IMPLEMENTATION ACTIVITIES AND SCHEDULE:

• Survey health providers
• Survey people with chronic illnesses
• Approach companies for donations
• (Raise money to buy equipment) (if donations are not sufficient)
• Obtain equipment, label, formulate storage and maintenance plans
• Review use of equipment with core training staff
• Form peer education groups
• Involve local community in trainings of equipment

return to top of page

OBJECTIVE OUTCOME MEASURES:
We will use two surveys to measure effectiveness:

Survey health providers at shelters:

• What equipment was available?
• What did they need or want?

This survey will be performed now, and immediately after each disaster.

Formulate a survey that health providers (in all disciplines) can use with their patients with chronic illnesses:

• Does the patient know how to operate simple equipment to monitor their illness?
• Does the patient own that equipment?

This survey will be performed now, after each disaster, and after every six months of peer education trainings.

return to top of page

ATTACHMENTS:
Tables:
Duplin County, North Carolina, total population 44,080
Approximate number of people with:

• Hypertension: >8,820
• Asthma: >2,200
• Diabetes Mellitus: >2,030

Duplin County North Carolina United States

% >65 yrs old 14.3% 12.5% 12.8%

% <poverty level 16.2% 13.8%

% minority 33.1% 24.8% 17.9%

return to top of page

References:
Andreoli, et al., Cecil Essentials of Medicine, 4th edition

Duplin County Health Department, Illa Davis, personal interview

Duplin County Department of Social Services, Elva Fisher, personal interview

North Carolina Department of Health and Human Services, www.dhhs.state.nc.us

North Carolina Medical Supply and Durable Medical Equipment Assistance Program (919) 843-7854, www.dhhs.state.nc.us/docs/floydmdicalhotline.htm

North Carolina State Center for Health Statistics, www.schs.state.nc.us/SCHS

IRHTP home | Division of Health Sciences | ECU Home |
Visitors | Faculty | Students | Community
Gen. Info | Faculty | Curriculum | Diabetes Module | Eval. Instruments

This site is best viewed with Netscape 4 or Internet Explorer 4 or better.
If you need to download an updated browser, please select these links.

This page was last updated: 12/16/2003