Community Chapter 20
Response to a disaster is in its final phase. Although still in the recovery phase of the response, an evaluation meeting is arranged. The purpose of the evaluation meeting is to: A) Analyze the strengths and weaknesses of the response and submit a plan to improve response in the future B) Create a report that emphasizes the cohesiveness of the departmental response to the disaster C) Analyze the effectiveness of the disaster relief teams from respondent states D) Create a postdisaster report for FEMA
Ans: A Feedback: An evaluation meeting, led by the local emergency response committee, takes place during the recovery phase. A detailed list of strengths and weaknesses, as well as successes and failures, should be developed. Following a thorough review of the responses, a final report is prepared with recommendations for improving emergency response in the future. The report should not emphasize the cohesiveness of the departmental response to the disaster but should consider both strengths and weaknesses of the response. The purpose should be to analyze the effectiveness of the plan, not the relief teams from respondent states. The primary purpose of the meeting is not to create a report for FEMA but to evaluate the local emergency response.
The nurse is a member of the emergency and disaster preparedness committee for an organization. The nurse's role is to head the data collection subcommittee. What are the key areas that would be included in your plan? A) Morbidity, mortality, mental health, and infectious disease B) Morbidity, mortality, displacement, and community infrastructure C) Morbidity, mortality, mental health, and chronic illness D) Morbidity, mortality, displacement, and healthcare workers
Ans: A Feedback: Disaster preparedness and management competencies include participation in the development of a data gathering system that addresses morbidity, mortality, mental health, and infectious disease. Although displacement of people due to a disaster, the status of community infrastructure, and the availability of healthcare workers are concerns during a disaster, they would not be key areas of concern for a data collection subcommittee.
The nurse is a member of a disaster team responding to a chemical disaster. The nurse assesses clients in a systematic fashion, concentrating on their ability to breathe. When entering the evacuation site, before the physical assessments, the nurse should: A) Don PPE B) Interview the client C) Report to the hot zone D) Request a HAZMAT expert to witness the client assessment
Ans: A Feedback: In the field, the public health nurse's response to a chemical incident is summed up in two words: "act quickly." Hazardous materials (HAZMAT) experts report to the hot zone on notification of the release of the chemical. The nurse may be asked to report to a temporary evacuation site, not the hot zone, where people exposed to the chemical are awaiting triage. Donning PPE must be the first priority. Then assessment of the victim's ability to breathe is necessary. Maintaining adequate respiratory function tops the list for effective client management in a chemical event. Keeping the victims in a sitting position with constrictive clothing loosened or removed is necessary. If the client cannot sit, the torso should be elevated. Interviewing the client should come later. There is no need to have a HAZMAT expert witness the client assessment.
The disaster is over and the team prepares to return to normal operations. Before disbandment of the team, it is essential to create a safe environment for the staff. The staff will participate in: A) Critical incident stress debriefing B) Support group to foster recovery C) Information debriefing for prevention purposes D) Interrogation process to identify unsafe behaviors
Ans: A Feedback: The recovery phase begins as the disaster ends. Although normal operations may return, critical incident stress debriefing for staff members is important. Responders may have been exposed to traumatic situations or worked for lengths of time that left them exhausted. An after-action evaluation is conducted following the event that includes the responders and agencies involved. Each step of the disaster event is reviewed, and a report is compiled that describes the scenario, response activities, participants, what went well, and what problems occurred. The financial, manpower, and other resources are determined. Lists of detailed recommendations are made for revisions to the emergency response plan. Arrangements are then to follow the progress of making the recommended changes. The final report assists with closure of the event and demonstrates that emergency preparedness is valued.
As a member of a disaster team, the nurse responds to a confirmed outbreak of the plague. The nurse understands that the pneumonic plague has a high mortality rate. The decision to meet the needs of the public on a wide scale includes: A) Administration of antibiotics via PODs B) Administration of antivirals via PODs C) Door-to-door visits to administer preventative medication D) Isolating designated hospitals to prevent spread of the plague
Ans: A Feedback: Without early treatment, pneumonic plague has a high mortality rate. Several types of antibiotics are effective in the treatment of all forms of plague. Should there be a confirmed bioterrorism attack, prophylactic distribution of antibiotics to the public would occur through POD sites. Antivirals would not be effective against the plague, which is caused by the bacterium Yersinia pestis. Door-to-door visits to administer preventative medication would not be feasible or necessary, given the availability of PODs. Isolating designated hospitals would not meet the needs of the public on a wide scale.
The nurse is in charge of implementing a personal protective equipment (PPE) program at the hospital, in response to a chemical terrorist attack. Which components should be included in this program? (Select all that apply.) A) Selection, maintenance, and use of PPE B) Training of employees in PPE use C) Identification of hazards present D) Identification of commodities to be distributed via POD emergency supply centers E) Clinical assessment and triage drills
Ans: A, B, C Feedback: The Occupational Safety and Health Administration (OSHA) has outlined four levels of personal protection and the types of equipment that should be worn in various emergency situations. The agent involved and the risk of exposure are the primary determinants of the level of PPE required. If PPE is to be used, a PPE program should be implemented that addresses the hazards present, the selection, maintenance, and use of PPE, the training of employees, and monitoring of the program to ensure its ongoing effectiveness. JITT videos are available for PPE training purposes. A PPE program would not need to include identification of commodities to be distributed via PODs or clinical assessment and triage drills, which would be covered in separate programs or training.
Five weeks after a category 4 hurricane, a town in southern Louisiana continues to battle for survival. The flood waters have now receded. The nurse is part of the disaster recovery team. Epidemiologic analysis of this town includes factors that influence the health status of this community. Which data may be included in the epidemiologic analysis report? (Select all that apply.) A) Continuing death B) Population shift C) Contamination of water supplies D) Limited access to places of worship E) Collapse of access to healthcare
Ans: A, B, C, E Feedback: An epidemiologic analysis of adverse health effects after any kind of disaster identifies factors that influence the health status of the community on a long-term basis. Some of these factors include continuing death, chronic illness, and/or disability; population shift if recovery is prolonged; contamination of food and water supplies, with an increased risk of infectious diseases; and collapse of local and regional healthcare access. Limited access to places of worship would not be included in the report, as it does not directly affect the health status of the community.
The management team is in the process of identification of hazards associated with the ice storm that is expected to disable electrical service to the city. To identify areas most vulnerable to damage and plan for an effective response, which data or methods of data collection may be used? (Select all that apply.) A) Geographic information B) Satellite imagery C) Census data D) Historical data on previous events E) Planning board declarations
Ans: A, B, D Feedback: The identification of all existing and potentially dangerous situations before disasters occur is the first step in planning for an effective response. Different circumstances result in different types of injuries or illness, damage, and disruption of communication and transportation. Gathering historical data about previous disasters is helpful. Aerial photography, satellite imagery, wireless remote sensing devices, and geographic information systems are tools commonly used in hazard identification. Census data would not likely help identify areas vulnerable to damage. Planning board declarations are not data or a method of data collection.
Which are advantages of disaster management JITT for nurses? (Select all that apply.) A) Is cost-effective because it requires the least amount of resources to produce the final result B) Provides the nurse with comprehensive knowledge of how to respond to many different types of disaster C) Shortens the period of time between learning and application D) Includes classroom sessions and on-site presentations E) Is offered online for easy access
Ans: A, C, D, E Feedback: Just-in-time training (JITT) is given immediately before it is used so that the least amount of resources is expended in producing the final result. There is a shortened period of time between learning and application. Options for JITT can include the following: 1-hour scheduled classroom sessions; an online video demonstration; or an on-site, show one-do one presentation. The Centers for Disease Control and Prevention offer many online JITT training sessions, and many states and localities have developed their own training programs. Because JITT is specific to an impending or current disaster, it does not provide the nurse with comprehensive knowledge of how to respond to many different types of disaster.
The community health nurse works in a receiving station after a radiological disaster. The nurse wears the requisite PPE and notes that the majority of the victims have blast injuries. A volunteer worker reports that many of the victims have dust on their clothes. The nurse's response to the dust is to: A) Recognize that the dust is common with blast injuries B) Consider it radioactively contaminated and notify HAZMAT C) Consider the dust a biological agent and therefore a contaminant D) Flush all wounds to prevent chemical contamination
Ans: B Feedback: Community-based nurses are not called to the actual location of a radiological disaster. However, nurses working in a receiving station may observe dust on arriving victims. It must be assumed that dust on victims is radioactive (not a biological agent). PPE should be worn, and HAZMAT should be notified. People should remove their clothing and be referred for decontamination. Open wounds should be cleaned and covered, not flushed.
The public health nurse works in New England during the winter months. An ice storm cripples the city, and electrical outages affect the power grid. Trees and frozen power lines are down throughout the city, and the timeline for restoration of power is 7 to 10 days. The management team should classify this occurrence as: A) An emergency B) A natural disaster C) Terrorism D) An accidental disaster
Ans: B Feedback: Natural disasters are the result of naturally occurring events that have an impact on the environment, the economy, and the people who live in the area. Emergencies are considered events that require a swift, intense response on the part of existing community resources. Disasters are often unforeseen, serious, and unique events that disrupt essential community services and cause human morbidity and mortality that cannot be alleviated unless assistance is received from others outside the community. Terrorism is defined by the United Nations as "any action intended to cause death or serious bodily harm to civilians or noncombatants with the purpose of intimidating a population or compelling a government or an international organization to do or abstain from doing any act." Accidental incidents (or disasters), broadly defined, are those that happen as a result of circumstantial factors (e.g., road conditions, human error, and physical plant deterioration) and are usually not deliberate.
The nurse is notified that a possible anthrax exposure occurred at the local military base. Civilian workers are routed to the local hospital's emergency department. The nurse's responsibility is to set up PODs in the community. The function of the PODs in response to the anthrax exposure is to: A) Distribute decontaminated food B) Administer prophylactic medications C) Distribute decontaminated water D) Provide triage
Ans: B Feedback: Postexposure prophylaxis for anthrax, which combines 60 days of antibiotics plus three doses of vaccine, is effective in preventing anthrax disease from occurring after an exposure. In an attack, public health nurses may set up PODs in their communities to administer prophylactic medications. Nurses also have the responsibility to educate the public about anthrax by managing "hotlines," answering questions, providing factual information, and offering reassurance. There would be no need for distribution of decontaminated food or water in this case. A POD would not be involved in triage.
The public health nurse is a first responder in a community disaster, secondary to a flood. One section of the town has experienced a loss of water and electricity for 4 days. The nurse's first action to meet the needs of the community at this time should be to: A) Refer the members of the community to a spiritual outreach program B) Provide access to safe food and water C) Inform the fire department of potential risks within the community setting D) Provide an immunization program
Ans: B Feedback: Public health nursing practice focuses on the provision of comprehensive public health services to ensure that community members have access to preventive care, immunizations, safe food and water, and assistance with services that may go beyond medical needs. An extensive knowledge of the community is the foundation for these services. However, the need for clean water and safe food is the priority at this time.
The nurse cares for a client who has symptoms of high fever and unexplained bleeding. After receiving blood test results, the client's primary care provider diagnoses the client with Ebola hemorrhagic fever. What interventions should the nurse anticipate implementing for this client? (Select all that apply.) A) Administration of an antiviral B) Strict infection control C) Isolation of the client D) Rinsing of the client's eyes E) Administration of an antitoxin
Ans: B, C Feedback: Ebola hemorrhagic fever is a severe, often fatal viral disease in humans, and it is one of the most virulent viral diseases known to humankind. No treatment or vaccine is available, and death occurs in 50% to 90% of all cases of clinical illness. Once illness is confirmed, isolation is enforced along with strict infection control techniques. Treatment with an antiviral or antitoxin would not be effective. Rinsing of the eyes is performed following a chemical disaster, not with the Ebola hemorrhagic fever.
A tornado touched down in the city. The public health nurse is a member of the disaster management team. The nurse's role includes: (Select all that apply.) A) Search and rescue B) Clinical assessment and triage C) Provision of health education D) Hazardous materials management E) Protection of property
Ans: B, C Feedback: Public health nurses can play a crucial role in all phases of disaster management. Nurses have a diverse knowledge base, well-developed risk assessment and clinical skills (including clinical assessment and triage), and a strong commitment to public welfare that bring depth to the disaster management process. Public health nurses are experts in providing health education for the various populations in a community setting. Historically, disaster management has been viewed as the responsibility of police, firefighters, emergency medical technicians, and hazardous materials (HAZMAT) management teams. Traditionally the first to arrive on the scene, they act to save lives (search and rescue), protect property, and meet basic human needs.
The nursing team cares for victims of a possible anthrax white powder investigation. Which information must be documented by the nurse scribe? (Select all that apply.) A) Victims' names B) Time and place C) Name of the Incident Commander D) General assessment of the field E) Victims' health histories
Ans: B, C, D Feedback: During an emergency event, it is not possible or expected that normal documentation standards and protocols will be maintained. When responding to an emergency, the time, place, general assessment of the field, and the name of the Incident Commander should be noted. Events move quickly, and documentation of observations is important. However, it is not possible to document all the information that is normally required, such as victims' names or their health histories.
After a hurricane, the nurse is placed on a planning committee to meet the direct needs of the community. Most of the clean-up and rescue work has been completed, and several members of the community are living in shelters and are homeless. One of the foremost priorities of the committees is to establish: A) Ecumenical centers for long-term worship B) Home repair resources C) POD emergency supply centers D) Financial aid centers
Ans: C Feedback: A point of distribution (POD) is a centralized location where the public picks up emergency supplies, including food, water, and medications (if necessary), following a disaster. Food, water, and medications would be considered a priority during the postdisaster phase of the planning.
The national weather service warns of an impending ice storm that may have crippling effects on the community. Widespread electrical outages are predicted as well as freezing temperatures. The community health nurses are mobilized to establish emergency living quarters and clinics for those without heat. The nurses' actions are occurring during which phase of the disaster? A) Impact B) Postimpact C) Preimpact D) Preparedness
Ans: C Feedback: Disasters have a timeline, often referred to as a life cycle or phases. These include the preimpact phase (before), the impact phase (during), and the postimpact phase (after). Actions taken during these phases affect the illness, injury, and death that occur following the incident. Although disasters vary significantly, the response to each is similar. Preparedness is not a phase of the disaster itself but of the emergency management response to the disaster.
The nurse is appointed to be a member of the risk communication team during a disaster response situation. During an evacuation, the nurse is informed that an increasing number of individuals are reluctant to leave their homes. To complete an orderly evacuation, it is necessary to: A) Involve the armed forces B) Declare martial law C) Create an environment of trust and credibility D) Disseminate information regarding the necessity of the evacuation
Ans: C Feedback: Risk communication often involves multiple messages between multiple groups concerning the nature of risk. The perception of the risk depends on the circumstances. For example, although a voluntary evacuation may produce anxiety, it is more acceptable than one imposed on citizens. Earning trust and credibility is essential for effective risk communication. It is especially important when dealing with the fear factor associated with a deliberate attack. During this process, public health officials and representatives must provide clear, accurate information in such a way that fear is minimized. Thus, it would not be appropriate to involve the armed forces or declare martial law. There is likely no time to disseminate information regarding the necessity of the evacuation.
An outbreak of foodborne botulism has occurred in the community, and the nurse is on the disaster management team to address it. Which intervention should the nurse expect to implement in this situation? A) Administration of antivirals B) Administration of antibiotics C) Distribution of personal protective equipment (PPE) D) Administration of antitoxins
Ans: D Feedback: In botulism, muscle weakness begins and descends through the body. At the point where breathing muscles are involved, ventilator assistance becomes necessary. Antitoxin must be administered because a toxin produced by Clostridium botulinum is the cause of the paralysis. A supply of this antitoxin is maintained by the Centers for Disease Control and Prevention. Antivirals and antibiotics would not be appropriate, as botulism is a toxin, not a virus or bacterium. Distribution of PPE would be unnecessary.
The nurse is responsible for triage in a setting where a natural disaster has occurred. The triage is expected to last for an extended period of time. Which triage model would be most effective in this scenario? A) Simple triage and rapid treatment (START) B) Prehospital triage C) JumpSTART triage D) Start/Save triage
Ans: D Feedback: START is a simple, prehospital triage system that was developed in California to assist emergency responders for use in earthquakes. Evidence-based and field-proven, the system separates injured people into four groups according to the severity of their injuries or illnesses. Other triaging systems have been developed to address the needs of vulnerable or special populations, such as the JumpSTART system for triaging children and the Start/Save system for triaging victims over a long period of time. The latter would be used when disasters are of such a nature that evacuation of the person to a field hospital is impossible.