December 2017 Dallas Medical Journal 11
uncertainty of internet connectivity in
the shelter, clinicians used paper medical
records. Daily abstraction of the records,
data entry and analysis of the cumulative
volume of >2,500 clinic visits required
teams of up to fi ve health department
epidemiologists and two volunteer medical
students working in shifts.
Th e high proportion (40 percent) of
registered evacuees seeking care at least
once at the shelter medical clinic supported
the value and need for having such a clinic
on-site. Although 36 – 40 percent of the
evacuees who registered at the convention
center were 18 years of age or younger, this
age group comprised only 18 percent of
patients seeking care at the clinic (Table 1).
Consistent with the sudden nature of
disasters where many evacuees need to
hurriedly escape without their medication
supplies, a high proportion of medical
visits primarily were for prescription refi lls
(27 percent). Indeed, two thirds of the
clinic patients were from the Beaumont,
Port Arthur and Orange areas (Figure 3).
Th ey told of wading through fl oodwaters
and spending nights in local malls and
shelters, before being fl own to Dallas.
Th e summary of reasons for visiting
the shelter clinic refl ected the diversity
of health issues encountered and the
spectrum of medical care needed (Table
2). Not apparent from the numbers were
the poignant and complex stories of some
of these patients, including the miraculous
recovery of the toddler found fl oating
face-down in fl oodwaters in her home,
the wheelchair-bound patient with endstage
cancer who needed continuation of
palliative care, the patient still searching for
his wife, and a patient fresh from the loss
of both his children in the fl oods.
With a goal of collecting data in order
to inform actions, the epidemiology data
teams tracked patient volumes by shift to
help project staffi ng needs in the clinic.
Numbers of patients seen for symptoms
of illnesses with outbreak potential (e.g.,
infl uenza-like illness, diarrhea, scabies,
lice, conjunctivitis) were assessed daily,
with non-isolated patients followed as
feasible for symptom progression. Patients
discharged to the isolation area also were
monitored until they met criteria for
release to general population cots.
Infection prevention and control
In smaller community evacuation
shelters, municipal and county sanitarians
are typically responsible for ensuring
basic environmental inspections and
infection prevention measures. 11–12
Ensuring robust infection prevention
measures in a megashelter that houses
thousands of people, however, can be
vastly more diffi cult. Greater levels of
staffi ng and expertise may be needed for
implementation of infection control,
particularly for large shelters with on-site
medical clinics. Not only is there a higher
potential ease of disease transmission
due to close quarters, but nonresidential
structures used as megashelters may not
have been designed to accommodate
thousands of people overnight, for weeks
at a time. For example, the formidable
necessary logistics include ensuring
procurement and placement of suffi cient
numbers of sinks with running water,
portable hand-washing stations, portable
toilets, portable showers, and handsanitizer
stations.
More than 1,300 Harvey evacuees
were received at the convention center
alone on Sept. 1, and by Sept. 2, the
total census of more than 2,400 at this
shelter had surpassed Hurricane Ike’s peak
census of 1,226 in 2008. Additionally,
the likelihood of an extended sheltering
operation was becoming evident from the
unfolding reports of the extent of fl ood
damage. We were tremendously grateful
to the infectious disease physicians and
infection prevention nurses in our area
who immediately responded to the need to
Figure 2. Figure 3.
Table 1: Characteristi cs of Pati ents Seen at the Conventi on Center Shelter Medical Clinic
Total from August 29 - September 20, 2017
Gender
Age (yrs)
Female
Male
< 5
5 to 17
18 to 65
> 65
Total Clinic Visits Total Pati ents
N %
2,654
1,544
1,110
N %
1,560
873
687
(58.2)
(41.8)
(56.0)
(44.0)
163
192
1,938
347
(6.2)
(7.3)
(73.4)
(13.1)
126
152
1,092
176
(8.2)
(9.8)
(70.6)
(11.4)
Total Daily Clinic Visits to Medical Clinic within Dallas Conventi on Center
Shelter for Harvey Evacuees: August 29 - September 20, 2017
Original Locale of Residence of Hurricane Harvey Evacuees
seen at Conventi on Center Shelter Medical Clinic