Disaster Management Exam 2

Role of the nurse in disaster response (Read over)

o The role of the nurse in disaster response depends on nurse's experience, professional role in a community disaster plan, specialty training, and special interest. o Nurses serve many roles: o Advocate for a safe environment Assessment of the community and individuals - They use the skills of interview, observation, individual physical examinations, health and illness screening, surveys, and records. - Elements of a rapid need's assessment include determining the magnitude of the incident, defining the specific health needs of the affected population, establishing priorities and objectives for action, etc. - Understand what community resources are available

What is the Disaster Medical Assistance team? who can this team be activated by (2)? what medical services are provided (2)? What are these teams used primarily for (1)? What does the Medical Reserve Corps and Community Emergency Response Team provide?

· In a presidentially declared disaster, including overseas war, the U.S. Public Health Service can activate disaster medical assistance teams (DMATS) to an area to supplement local and state medical care needs. o DMATS can also be activated by the Assistant Secretary for Health if requested to do so by a state health officer. · Teams of specially trained civilian physicians, nurses, and other health care personnel can be sent to a disaster site within hours of activation. · DMATS can provide triage and continuing medical care to victims until they can be evacuated to a national network of hospitals prearranged by the NDMS · Because of the nature of this country's disasters since the initiation of DMATS, these teams have been used primarily to staff community health outpatient clinics in the affected areas. - The Medical Reserve Corps (MRC) and the Community Emergency Response Team (CERT) provide opportunities for nurses to support emergency preparedness and response in their local jurisdictions.

Why has urbanization and overcrowding of cities increased the danger of natural disasters and what has it led to major increases in? what is Complex Humanitarian Emergency (CHE)? in some parts of the world, what have modern wars waged over?

· The urbanization and overcrowding of cities have increased the danger of natural disasters because communities have been built in areas that are vulnerable to disaster, such as in tornado zones or near rivers or flood plains. o Have led to major increases in insurance payouts in the United States o Complex Humanitarian Emergency (CHE) - These emergencies result from a "humanitarian crisis in a country, region or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single and/or ongoing UN country programme. · In some parts of the world, modern wars waged over land rights and space have markedly increased the risk for injury and death from disaster

What can cause fear in children in regards to disasters and why (2)? what is the best thing to do at this time (2)? what also influences the child? what population may be overlooked in disasters?

- Children not immediately affected by a disaster also can experience effects from it. - The constant bombardment of disaster stories on television can cause fear in children. - They may believe that the event could happen to them or their family, believe someone will be injured or killed, or think they will be left alone. - It is best to turn off the television news and engage in activities with family, friends, and neighbors. - The parents' reaction to a disaster greatly influences children - One special population that may be overlooked is children in childcare facilities. Children are cared for in many different locations - They have little security against a disaster

Healthy people 2030 (read over)

- Disasters clearly affect the HP 2030 objectives that relate to unintentional injuries, occupational safety and health, environmental health, and food and drug safety. - People have become even more aware of the importance of disaster preparedness and how the things they take for granted such as safe food, water, and housing can be threatened. - OSHA, EPA (environmental protection agency) **

4 stress reactions to disasters, what is the reconstruction phase? how long is it and what is the goal? the first two stages are associated with? the last two stages are associated with?

- Reconstruction (longest phase) o Homes, schools, churches, and other community elements need to be rebuilt and reestablished o The goal is to return to a new state of normalcy · The heroic and honey- moon phases-are most often associated with response efforts. · The latter two phases-disillusionment and reconstruction- are most often linked with recovery.

What is SAMHSA? levels of prevention graph (read over)

- SAMHSA (Substance Abuse and Mental Health Services Administration): deals with emergency management/ emergency disaster, mental health, get some data, different programs going on, EBP, can be used to educate other patients that are credible, not only resources that we have at the hospital or clinics, mental health is sky rocket right now, not only in adults but in children, a lot of people have mental conditions now (whether anxiety, OCD, etc.) - PAGE 12 STUDY GUIDE

What is a disaster? Why has increased in regards to disasters (2)? Why has the cost of recovery from a disaster has risen? If the state applied for state of emergency, who pays for the funds? when they recover individuals, where do they go? what are nurses getting involved in (3)?

o What is a disaster? A disaster is an event that causes human suffering and demands, more resources that are available in the community o The number of disasters, both human-made and natural (or combination of both), continues to increase, as does the number of people affected by them. o The cost to recover from a disaster has risen sharply because of the amount of technology that must be restored. - Think about money, compensation, we need money to fix things - For example, the current disaster in south beach, the people helping aren't there for free - how do we get that money? Florida applied for a state of emergency so were waiting for federal funding - How many people and what type of equipment to perform the rescue? The people working there, they have to drink water, eat, electrolyte replacement, these people need to wear their equipment or vests ... very hard work - If they recover individuals, where do we take them? One hospital cannot manage one particular area of disaster - we need to disperse the individuals o Nurses are increasingly getting involved in disaster planning, response, and recovery through their local health department or local government.

Capestone (Read over)

· The Capstone Exercise for 2014 examined the nation's collective ability to coordinate and conduct risk assessments and implement National Frameworks and associated plans to deliver core capabilities · The Homeland Security Exercise and Evaluation Program (HSEEP) was developed to help states and local jurisdictions improve overall preparedness with all natural and human-made disasters (HSEEP is the national standard for all exercises) o It provides a standardized methodology and terminology for exercise design, development, conduct, evaluation, and improvement planning and assists communities to create exercises that will make a positive difference before a real incident

Nurse involvement in prevention (read over)

- Awareness and education: Holding or attending community meetings on disaster preparedness, including informing the community about the many educational resources available to them. - Organizing and participating in mass prophylaxis and vaccination campaigns to prevent, treat, or contain disease. - Advocacy identifying environmental hazards, serving on the public health team for mitigation work, supporting actions and efforts for effective building codes and proper land use. o Because disasters are both natural and human-made, nurses need to assess for and report environmental health hazards, including unsafe equipment and faulty structures. o They must be aware of high-risk targets and current vulnerabilities and what can be done to eliminate or mitigate the vulnerability. o Targets may include military and civilian government facilities, health care facilities, international airports and other transportation systems, large cities, and high-profile land- marks. o Terrorists might also target large public gatherings, water and food supplies, banking and finance, information technology, postal and shipping services, utilities

How long may it take for a bioterrorism attack to be noticed (2)? what are the five component of a comprehensive public health response to outbreak of illness (5)? what the feelings of people who have survived a terrorist attack (5)?

- Biological or chemical terrorist attacks require a very different response. - An unannounced dissemination of a biological agent may easily go unnoticed, and the victims may have left the area of exposure long before the act of terrorism is recognized. - The first signs that a biological agent has been released may not be apparent for days or weeks, when the victims become ill and seek a health evaluation. - In this case the health care professionals, including nurses, are considered the "first on the scene." - Five components of a comprehensive public health response to outbreaks of illness are (1) detecting the outbreak; (2) determining cause; (3) identifying factors that place people at risk; (4) implementing measures to control the outbreak; (5) informing the medical & public communities about treatments, health consequences, and preventive measures - People who experience or witness a terrorist attack may experience a stress response as well as one or more of the following symptoms: - (1) repeated thoughts about the attack; (2) immense fear of everything, which may prevent them from even leaving their homes; (3) survivor guilt or questioning why they lived, and others did not; (4) a sense of great loss; and (5) hesitation to express feelings.

What are important components of preparedness at the community level (1)? what type of drills can be done (3)? what is operations-based events involve? What was the fist major exercise conducted by the US? participation in these exercises are important bc (2)?

- Disaster and mass casualty drills and exercises are valuable components of preparedness. - Exercise categories include discussion- based simulations, or "tabletops," and operations-based events, such as drills and functional and full-scale exercises - Operations-based events involve escalating scope and scale testing of the disaster preparedness and response network using a specific plan. - National Level Exercise 2009 (NLE09) was the first major exercise conducted by the U.S. government that focused exclusively on terrorism prevention and protection, as opposed to incident response and recovery. - These exercises started out as the Top Officials exercise series (TOPOFF]) but now incorporate the whole community, with an understanding that the practice must reach all levels of the public, private, and government sectors to be effective. · Participation in exercises, simulations, or other activities, including real world incidents, helps organizations validate their capabilities and identify shortfalls, pulling in their partners and stakeholders including citizen participation

What is a disaster? who can it affect (2)? what can increase the effect of a disaster? what are the characteristics of a disaster (3)? why do developing countries burden from natural disasters (2)?

- Disaster: any natural or human-made incident that causes disruption, destruction, and/or devastation requiring external assistance - Can affect a single family or a small group, as in a house fire, or they can kill thousands and have economic losses - Although natural events such as earthquakes or hurricanes often trigger disasters predictable and preventable human-made factors can increase the effect of the disaster. - Range in size - Are expensive (lives affected, property lost/damaged) - Developing countries experience disproportionate burden from natural disasters - These countries are usually poor and have limited resources for dealing with the aftermath - Disasters have political aspects in addition to the enormous losses to the people - Example: some countries will not accept aid from nations they do not consider allies or supporters.

4 stress reactions to disasters, what is the Disillusionment phase (3)? what must the nurse consider and identify?

- Disillusionment o Occurs after time elapses and people notice that additional help and reinforcement may not be immediately forthcoming. o A sense of despair results, and exhaustion starts to take its toll on volunteers, rescuers, and medical personnel. o The community begins to realize that a return to the previous normal is unlikely and that they must make major changes and adjustments. o Nurses need to consider the psychosocial impact and the consequent emotional, cognitive, and spiritual implications. o Public health nurses should identify groups and population segments particularly at risk for burnout and exhaustion, to include responders and volunteers involved in rescue efforts.

What is the Emergency management responsible? what is FEMA? what is the benefit of a stronger predisaster partnership (1)? why is it important to have back up plans with disasters (2)?

- Emergency management is responsible for developing and Coordinating emergency response plans within their defined arca, whether local, state, federal, or tribal. - The Federal Emergency Management Agency (FEMA) coordinates comprehensive, all-hazard planning at the national level, assuring a menu of exercises and plan templates to address plausible incidents in any given community. - Emergency management personnel at the state and local levels work closely with their communities and response partners, providing opportunities to train, exercise, evaluate, and update disaster plans. - Stronger predisaster partnerships, which include all stakeholders, produce a more coordinated response. - Disaster planning involves simplicity and realism with backup contingencies because (1) the disaster will never be an "exact fit" for the plan, and (2) all plans must be implementation ready, no matter who is present to start them

What is included in the emergency supplies kit (7)?

- Emergency supplies kit - Gather emergency supplies and store them in a sturdy, easy-to-carry container. - Keep important documents in a waterproof container. - The following are emergency supplies: - A 3-day supply of water (1 gallon per person per day) and food that will not spoil. - A change of clothing, protective footwear, blanket, sleeping bag per person - A first-aid kit that includes a week's supply of your family's prescription medications and over-the-counter medications you take. - Emergency tools, including a battery-powered radio, flash-light, and plenty of extra batteries. Candles and matches. - Documents: Identification, passport, birth certificate, insurance policies, family contact information, local maps with marked evacuation routes, some money.

What is the Emergency Support Functions? what do those functions include (3)?

- Emergency support functions (ESFS) - The 15 ESFS provide a mechanism to bundle federal resources and capabilities to support the nation. - Functions include transportation, communications, public works and engineering, firefighting, information and planning, mass care, emergency assistance, temporary housing and human services, logistics, E public health and medical services, search and rescue, oil and hazardous materials, agriculture and natural resources, energy, public safety and security, long-term community recovery, and external affairs/standard operating procedures and energy. - Each ESF includes a coordinator function, and both primary and support agencies that work together to coordinate and deliver the full breadth of federal capabilities.

In a community, is a warning system important to have for a disaster and why? why are people reluctant to leave their homes during a disaster (2)? who can speak to these individuals to help convince them (1)? Some people believe that experience with one disaster, is?

- Finally, the community must have an adequate warning system and a backup evacuation plan to remove those individuals from areas of danger who hesitate to leave. o Some people refuse to leave their homes because they are afraid their possessions will be lost or destroyed by the disaster or from looting after the disaster. o Law enforcement personnel or others in authority may have to speak directly to these reluctant residents to convince them to leave their homes and go to safer quarters. - Also, some people mistakenly believe that experience with a particular type of disaster is enough preparation for the next one. o People must be convinced that predisaster warnings are official, serious, and personally important before they are motivated to take action.

What are the 4 stress reactions to disasters? What is the heroic stage? What is the honeymoon stage and what occurs?

- Heroic, honeymoon, disillusionment, and reconstruction - Heroic o There is overwhelming need for people to do whatever they can to help others survive the disaster. o First responders, who include health and medical personnel, will work hours on end with no thought of their own personal or health needs. - Honeymoon o Survivors may be rejoicing that their lives and the lives of loved ones have been spared. o Survivors will gather to share experiences and stories. The repeated telling others creates bonds among the survivors. o A sense of thankfulness over having survived the disaster is inherent in their stories.

In response to bioterrorism, what is the first priority and why? Why is recognizing a biological agent difficult (2)? what agents can be used to create biological weapons (3)? what is the likely vehicle for dissemination (2)? what is going to occur to the individuals that were infected? what does the Pandemic and All-Hazards Preparedness Reauthorization Act help with?

- Identifying the chemical or biological agent is the first priority. o Rapid identification is vital to protect health care workers and any others affected. o Results of a biological release are hard to recognize because many biological agent symptoms mimic influenza or other viral syndromes. o Pathogens such as bacteria, viruses, and toxins can be used to create biological weapons. o Although an aerosol release may be a likely vehicle for dissemination, certain biological agents could also be released through the water and food supply. - Quarantine of those exposed to contagious agents may be considered in some instances. - Through the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA), several biodefense programs exist to help public health professionals mount a proactive response to these events:

What is prevention? what are some examples? what should be determined prior to disasters (4)? prevention also includes human-made hazards such as?

- Includes activities to prevent natural and man-made disasters, such as increasing surveillance, improving inspections and airport security, strengthening public health processes such as immunizations, isolations, and quarantine - Activities such as strengthening barriers to prevent flooding and teaching methods to prevent communicable disease transmission - Community threats, vulnerabilities, and capabilities are determined such as demographic areas - Populations at risk: those that have fewer resources, without them they can be harmed - All-hazards mitigation (prevention) is an emergency management term for reducing risks to people and property from natural hazards before they occur. - Prevention can include structural measures, such as protecting buildings and infrastructure from the forces of wind and water, and nonstructural measures, such as land development restrictions. - Prevention also includes human-made hazards and the ability to deter potential terrorists, detect terrorists before they strike, and take action to eliminate the threat - Prevention activities may include heightened inspections; improved surveillance and security operations; public health and agricultural surveillance and testing; immunizations, isolation, or quarantine; and halting chemical, biological, radiological, nuclear, and explosive threats

International relief efforts (Read over)

- International relief efforts - think about what happened a while back in Haiti, all the help they needed that we were able to provide - Psychological stress of disaster workers

What is the National Incident management system? (rest, read over)

- Is the national platform for disaster response, and it includes universal protocols and language. - The NIMS identifies concepts and principles that answer how to manage emergencies from preparedness to recovery regardless of their cause, size, location, or complexity. - NIMS provides a consistent, nationwide approach and vocabulary for multiple agencies or jurisdictions to work together to build, sustain and deliver the core capabilities needed to achieve a secure and resilient nation" - No matter what type of nursing practice or which agency a nurse chooses, he or she will come into direct contact with NIMS, which includes the Incident Command System - The NIMS includes varying levels of education and training, with many organizations requiring a base level of familiarization to comply with federal funding requirements.

What is the purpose of the National Health Security Strategy? what do outcomes include (3)? what is it built on the premise of (2)?

- National Health Security Strategy (NHSS) · The purpose is to reconnect public health and medical preparedness, response, and recovery strategies to ensure the nation's resilience in the face of health threats or incidents with potentially negative health consequences. · Outcomes of the NHSS include community strengthening, integration of response and recovery systems, and seamless coordination among all levels of the public health and medical system · The NHSS is built on the premise that healthy individuals, families, and communities with access to health care and knowledge become some of our nation's strongest assets in disaster incidents.

What is the National incident management system? What is the Public health and medical preparedness and the national health security strategy? what are the 4 critical component of public health and medical preparedness? what is the overall goal?

- National Incident Management System - National Incident Management System (NIMS), a unified, all-discipline, and all-hazards approach to domestic incident management - The NIMS was established to provide a common language and structure to help those involved in disaster response to communicate together more effectively and efficiently. - Public health and medical preparedness and the national health security strategy - HSPD 21 established a national strategy that enables a level of public health and medical preparedness sufficient to address a range of possible disasters. - It does so through four critical components of public health and medical preparedness: (1) bio surveillance, (2) countermeasure distribution, (3) mass casualty care, and (4) community resilience. - The NHSS focuses on the national goals for protecting people's health in the case of disaster in any setting.

What is the National preparedness guidelines? what is the National Response Framework and what are the 5 frame works? what is the Emergency Support Function 8?

- National Preparedness Guidelines - The National Preparedness Goal maintains the goal of "A secure and resilient nation with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk" - Same five frameworks as in the National Response Framework. - National Response Framework - Provides context for how the whole community works together and how response efforts relate to other parts of national preparedness - Each of the five-frame works covers one mission area: Prevention, protection, mitigation, response, or recovery - There are also 15 emergency support functions. · Emergency Support Function 8: Public Health and Medical provides coordinated federal assistance to supplement state, local, tribal resources in response to public health and medical care needs

Future of Disaster Management (Read over)

- Nurses must continue to plan and train in all-hazards environment, regardless of specialty practice. - Paramedics and firemen are excellent in this bc they are training all the time - They have to be ready all the time to act/ help - The nature of disasters will retain the element of unpredictability. - That unpredictability and the medical and public health surge requirements in disaster make prevention and preparedness activities on the part of individuals and communities even more important. o Define the nursing role in 1st, 2nd, and 3rd level triage: it's not the same triage we do in the hospital, how do we triage at the hospital? Flow nurse asking what brings you in today, takes vitals, puts you in a room, and begin assessment - we do on level of acuity. Chest pain would be a bigger priority over a stomach ache o In the community, a mass casualty like we have right now... we can't do that o In the community there is only 1 of me in a big community, we need help so we treat the patients that can help so we can get more help out there o Chapter 14 - page 236, 239, 251 (for levels of prevention practice)

What can the nurse consider in the event of being called to a disaster? what do special needs shelters require beforehand? do shelters allow pets? what can be done to protect the pets (3)? what can be included in the personal checklists (2)?

- Nurses should consider several contingencies for children and seniors with a plan to seek help from neighbors in the event of being called to a disaster. - Many special-needs shelters encourage preregistration for physically or mentally challenged people. · Because most shelters do not allow pets other than "pocket" pets, other arrangements will need to be made, such as going to a special pet shelter or placing the pet in a bathroom with sufficient food and water. · A note should be placed on the front door for emergency personnel as to where the pet might be found. - Personal checklist: for example, nurses think about the elderly, their emergency bracelet, pull alarms

Who is often the first responder? What is Triage and when should it begin? what is highest, secondary and last priority? Levels of disaster management are (4)? as the role of the nurse, what is going to be asked during the risk assessment (3)?

- Often the nurse is the first responder - Case finding and referring, Prevention, Health education, Surveillance - Triage: This will be put aside temporarily so that the nurse can deal with life threatening problems - Once rescue workers arrive on the scene, plans for triage should begin immediately - Triage is the process of separating casualties and allocating treatment on the basis of the victims' potential for survival. - Highest priority is always given to victims who have life-threatening injuries but who have a high probability of survival once stabilized. - Second priority is given to victims with injuries that have systemic complications that are not yet life threatening and could wait 45 to 60 minutes for treatment. - Last priority is given to those victims with local injuries without immediate complications and who can wait several hours for medical attention. o Levels of disaster management, start with mitigation (the prevention), preparedness, response (think about FEMA, it's our friend, along with CDC, American Red Cross, the OEM [office of emergency management] and the department of homeland security), and our recovery phase ****** o As the role of the nurse, we do a risk assessment, ask questions and think outside the box, what are the populations at risk within the community? Have the previous disasters been man-made, what size of the area is likely to be affected? ******

How do older adults react to disasters and what does it depend on? what does the need for relocation depend on (2)? How may children respond to disasters (3)?

- Older adults' reactions to disaster depend a great deal on their physical health, strength, mobility, independence, and income. - They can react deeply to the loss of personal possessions because of the sentimental value attached to the items and their irreplaceable value. - Their need for relocation depends on the extent of damage to their home or their compromised health. - The effect of disasters on young children can be especially disruptive - Regressive behaviors such as thumb sucking, bedwetting, crying, and clinging can occur. - Children tend to reexperience images of the traumatic event or have recurring thoughts or sensations, or they may intentionally avoid reminders, thoughts, and feelings related to disaster events. - Children may have arousal or heightened sensitivity to sights, sounds, or smells and may experience exaggerated responses or difficulty with usual activities.

In regards to personal preparedness, nurses who are disaster victims will experience? What is an example of a young nurse with a child priority? Why is family preparation important in nursing? How do nurses respond in regards to disasters? what must the public health nurse have in order before a disaster (3)?

- Personal preparedness - Nurses who are disaster victims themselves and must provide care to others will experience considerable stress. - Conflicts between family and work-related duties are inevitable. - For example, a nurse who is also the mother of a young child will not be able to participate fully, if at all, in disaster relief efforts until she has made arrangements for her child. - Advance personal and family preparation can help ease some of the conflicts that arise and allow nurses to attend to client needs sooner. - Disasters require nurses to respond quickly and preparedness is multifaceted - Public health nurses need to have their own personal plans in place before a disaster. o The family of each nurse must also be included and informed about the disaster plan. o One way a nurse can ensure that his or her family is protected is by providing them with the skills and knowledge to help them cope with a disaster.

The Presidential Policy Directive emphasizes that true preparedness is ? who is involved in the community preparedness (6)? what helps bridge barriers prior to disasters (2)? should relationships be established before hand? what are some boundaries (3)?

- Presidential Policy Directive (PPD)-8 emphasizes that true preparedness is a whole community event. - PPD-8 urges the strengthening of our nation's security and resilience through an integrated set of programs, and processes to implement the national preparedness goal - Planning and implementation require a coordinated response that involves the general public. - Community preparedness also involves all levels of government, public health agencies, hospitals, first responders, emergency management, health care providers within the community, schools and universities, the private sector, and business and nongovernmental organizations (NGOS) such as the ARC. - Mutual aid agreements and prior planning help to bridge perceived and actual barriers; establish relationships before the incident at the local, regional, state, and national levels; and ensure seamless service. - Sometimes barriers involve regulatory authority and jurisdictional boundaries; sometimes the barriers involve organizational control versus the common good.

What do nurses working in shelters need to do (5)?

- Provide assessments and referrals - to determine what type of facilities is most appropriate for the pt - Meet health care needs, such as helping clients get prescription glasses, medications, first aid, and appropriate diet adjustments. - Think about medications, the people affected do they have enough medication at home? Insulin is supposed to be in the refrigerator, in this heat it can go bad - Keep client records & Ensure emergency communications. - How to communicate if there is no communication available? Is there radios or walky-talky's to communicate - Provide a safe environment and using common-sense approaches to help shelter residents - These measures include listening to victims tell and retell their disaster story and current situation; encouraging residents to share their feelings with one another if it seems appropriate to do so; helping residents make decisions; delegating tasks, etc.

What is the Recovery phase? during this phase, what do agencies do (2)?

- Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level prior to the disaster as is possible (Often the hardest part of the disaster) - Now we need to do cleaning, ex: in south beach, not only do they need to clean the huge mess they need to locate the individuals - The dust around the area, if they have asthma, they can't be living in the area, the businesses in the area are probably closed, they're losing money. It affects everyone in that particular area - During the Recovery period, all involved agencies pull together to restore the economic and civic life of the community, to restore the institutions and properly rebuild

Who is responsible for setting up shelters (2)? which individuals are priority for shelters (3)? What does the American Red Cross do (2)? Why are nurses ideal shelter managers?

- Shelters are generally the responsibility of the local ARC chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. - Although initially physical health needs are the priority, especially among older adults and the chronically ill, many of the predominant problems in shelters revolve around stress. - Local Red Cross chapter - American red cross responds to a lot of things, not only natural disasters but fires, they have funds, help, and referrals o Nurses make ideal shelter managers and team members because they are comfortable with dealing with aggregate health promotion, disease prevention, and emotional support.

Who qualifies for a special needs shelter? Who provides assistance to special needs shelters (1)? whta do these shelters reduce (2)? what occurs if too may referrals are made to special needs shelters?

- Special Needs shelters - Individuals who are medically dependent and not acutely ill but have varied physical, cognitive, and psychological conditions should be directed to a special needs shelter. - The federal government provides assistance to special needs shelters - Special needs shelters reduce the surge demands on hospitals and long term care facilities that often occur during disasters - Although helpful in reducing surge, too many referrals can create tension among the special needs shelters, the regular shelters, and the health care facilities as roles and responsibilities become blurred and overall resources and personnel are limited.

What does the US Department of Homeland Security do in regards to disasters (2)? every aspect of disaster management involves? what is the Pandemic and All Hazards Preparedness Act? what is that act now called and what does it do additionally (3)?

- The U.S. system for homeland security includes public health preparedness and response as a core part of its national strategies. - Every aspect of disaster management involves public health nursing. - The NHSS was directed by the 2006 Pandemic and All-Hazards Preparedness Act (PAHPA). - The goal of this act is to improve the nation's ability to detect, prepare for, and respond to a variety of public health emergencies. - Now called the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA). - The PAHPRA funds public health and hospital preparedness programs, medical countermeasures under the BioShield Project, and enhances $1 the authority of the Food and Drug Administration

Role of the nurse in disaster recovery (Read over)

- The role of the nurse in the recovery phase of a disaster is as varied as in the prevention, preparedness, and response phases, and the three levels of prevention are used - Flexibility is essential in the recovery operation. - To determine effective interventions to ensure the best possible outcomes, it is essential to have ongoing accurate data about the population. Some conditions are manifest only after time elapses. - A major advantage of the recovery community assessment efforts is that they can be more in-depth, with greater confidence in the results. - Nurses will engage in ongoing community assessments during the recovery phase. - It is important to have a realistic perspective related to how long recovery may take - Teach proper hygiene and make sure immunization records are current. - Make referrals to mental health professionals. - Although most people eventually recover from disasters, acute and chronic illness can worsen by the prolonged effects of disaster.

What can be done to reduce accidents and destruction during natural disasters (2)? What does the National Preparedness Guide do?

- There are ways to prevent or manage how people and their communities respond to disasters. - Although the number of disasters worldwide continues to grow, what can be done to decrease accidents/death/destruction? o Although natural disasters cannot be prevented, much can be done to prevent further increases in accidents, death, and destruction after impact. - A concise, realistic, and well-rehearsed disaster plan is essential. - Open, clear, and ongoing communication among involved workers and organizations is critical. o The Presidential Policy Directive 8: National Preparedness (PPD-8) guides how the nation, from the federal level to private citizens "prevent, protect against mitigate the effects of, respond to, and recover from those threats that pose the greatest risk to the security of the nation"

In regards to professional preparedness, what should the public health nurse understand (2)? what is disaster management in the community about (3)?

- These public health nurses take time to read and understand workplace and community disaster plans and participate in disaster drills and community mock disasters. - Disaster management in the community is about population health, and the three core public health functions are used just as in day-to-day operations. · You would rely on assessment, policy development, and assurance in disaster work.

What are the different types of disasters (7)? why does human-made disasters occur (2)? what local area would be exposed to radiation if a disaster occurred in that area?

- Types of disasters - Natural disasters - Human-made disasters - Overcrowding and urban development have also increased human-made disasters. The stress caused by overcrowding has caused civil unrest and riots. - Chemical - Biological - Radiologic - Nuclear - Explosive - What do we have very close by if something were to happen, we would be exposed to radiation? Turkey point - it would go from homestead to Orlando

What are the factors that will influence how an individual responds to a disaster (5)? how do people respond to disasters? people who are affected often have exacerbations of (1) and why?

- When disaster hits, people in a community will be affected Physical and emotionally, depending on the: - Type, cause, and location (ie: Miami versus rural area, etc.); can cause depression or PTSD - Magnitude and extent of disaster - Duration of disaster (How fast/slow of progression) - Amount of warning - how long did the community have to prepare for this disaster? - Stress reactions in individuals vary o People react to the same disaster in different ways, depending on their age, cultural background, health status, social support structure, and general ability to adapt to crises. - People who are affected by a disaster often have an exacerbation of an existing chronic discase. - Grief results in harmful effects on the immune system.

What does ARC offer? what type of education will be provided? what does the National Disaster Medical System enable nurses to do?

- ARC and FEMA - The ARC offers training in disaster health services and disaster mental health for both response in local jurisdictions and national deployment opportunities. - In addition, the ARC provides a comprehensive program of disaster training for health professionals, to enable them to provide assistance within their own communities and to other affected communities and countries. · The courses teach nurses how to adapt their existing nursing skills to a disaster setting and to the scope of ARC disaster nursing, · Note that the knowledge the nurse will need for chemical, biological, radiological, nuclear, and explosive (CBRNE) disasters and those involving weapons of mass destruction (WMD) requires a base of specialized information. · The National Disaster Medical System (NDMS) enables nurses to work on specialized teams such as the Disaster Medical Assistance Team (DMAT).

What environmental hazards should be identified during the recovery phase of a disaster (4)?

- Be alert for environmental hazard during the recovery phase of a disaster - During home visits, nurses may uncover situations such as a faulty housing structure or lack of water or electricity. - Objects that have been blown into the yard by a tornado or that floated in from a flood may be dangerous and must be removed. - Also, the nurse should assess the dangers of live or dead animals and rodents that are harmful to a person's health. - Case finding and referral are critical during the recovery phase and may continue for a long time.

International Council of Nurses Fact Sheet (Read over)

- The International Council of Nurses Fact Sheet on terrorism and bioterrorism provides useful details on each of the following actions: - Help people cope with the aftermath of terrorism - Allay public concerns and fears of bioterrorism - Identify the feelings that you and others may be experiencing - Assist victims to think positively and to move to the future - Prepare nursing personnel to be effective in a crisis or emergency situation

What is BioWatch? what is BioSense? what is Project BioShield? what is Cities Readiness Initiative? What is Strategic National Stockpile? What did the CDC develop to keep the public community informed? (Rest, read over)

o BioWatch is an early warning system for biothreats that uses an environmental sensor system to test the air for biological agents in several major metropolitan areas. o BioSense is a data-sharing program to facilitate surveillance of unusual patterns or clusters of diseases in the Unitec States. - It shares data with local and state health departments and is a part of the BioWatch system. o Project BioShield is a program to develop and produce new drugs and vaccines as countermeasures against potential bioweapons and deadly pathogens. o Cities Readiness Initiative is a program to aid cities in increasing their capacity to deliver medicines and medical supplies during a large-scale public health emergency such as a bioterrorism attack or a nuclear accident. o Strategic National Stockpile (SNS) is a CDC-managed program with the capacity to provide large quantities of medicine and medical supplies to protect the American public in a public health emergency to include bioterrorism. - In an effort to keep the public health community informed, the CDC developed the Public Health Information Network (PHIN). - The PHIN provides for the electronic exchange of information among governmental agencies. o It focuses on six components that help ensure information access and sharing: - Early event detection, outbreak management, connecting laboratory systems, countermeasure and response administration, partner communications and alerting, and cross-functional components, and is critical to information exchange.

Why is disaster recovery efforts expensive (2)? why are people in industrialized countries less self-sufficient (2)? Which individuals are the first to be affected when disaster strikes? Why has the number of lives lost decreased in regards to disasters (2)? What is the downside of disasters in less developed countries in regards to buildings? which groups of individuals are most vulnerable (5)?

o Disaster recovery efforts are expensive, and the costs are growing because of the number of people involved and the amount of technology that must be restored. o People in industrialized countries are becoming less self-sufficient because they rely heavily on technology and social and economic systems within their community. · People who live on the brink of disaster every day, physically, emotionally, or economically, are among the first to be affected when disaster strikes. · Although the number of disasters worldwide continues to grow, the number of lives lost has decreased. o The increase in the number of lives saved may be due to better disaster forecasting and early warning systems that help people better prepare for the impending disaster. · Disasters in less developed communities can also destroy decades of progress in a matter of hours, in a manner that rarely happens in more developed countries. o The poor, elderly, ethnic minorities, people with disabilities, and women and children in developing communities are excessively affected and least able to rebound

Role of the nurse in disaster Preparedness (Read over)

o Help initiate or update the agency's disaster plan o Provide educational programs and materials regarding disasters specific to the area. o Organize disaster drills. o Provide an updated record of vulnerable populations within the community. o Review individual strategies. o Think about this being a nurse in the community, if you work in a home health agency you have level 1, 2, 3 patients - where you need an emergency backup plan, who needs oxygen, who's on different pumps, who needs an IV - Important to know these things bc once the governor says were in a state of emergency we need to act accordingly, can these pt's stay home, do they have generators, can we send them to a hospital/ shelter? - We need things organized and planned

What are the activities in which nurses can teach their families about (5)? what type of vulnerable infrastructure should be pointed out (3)? what enhances the ability to bounce back after a disaster?

o Long-term benefits will come by involving children or adolescents in activities such as writing preparedness or response plans, rehearsing the plan, preparing disaster kits, becoming familiar with their school emergency plan and where families should reunite in the event of an emergency, finding out where the evacuation shelters are located and identifying the evacuation routes, and learning about the range of potential hazards in their vicinity. - Vulnerable types of infrastructure such as dams, chemical plants, bridges, and transportation should be pointed out. - The ability to control as much as they can during each phase of a disaster provides them with the ability to bounce back

What is the first goal of any disaster response? what are basic needs people need access to (6)? what may hamper relief efforts (2)? What type of outbreaks may occur in the recovery phase? Sept 11 and Hurricane Katrina (read over)

o The first goal of any disaster response is to reestablish sanitary barriers as quickly as possible. o Water, food, waste removal, vector control, shelter, and safety are basic needs. o Difficult weather conditions such as extreme heat or cold can hamper efforts, especially if electricity is affected. o Infectious disease outbreaks occur in the recovery phase of disasters, and occasionally disaster workers introduce new organisms into the area. o The psychological effects of September 11, 2001 were different from those of more contained, single-event disasters. o The attack was totally unexpected and of great magnitude, with much uncertainty and fear about what might happen next. Not knowing when or if a subsequent attack will occur may prevent individuals from moving beyond their fear and anger o Also, Hurricane Katrina, which started as a natural disaster, had its consequences compounded by a human-made disaster caused by flooding from levee failure.

Who are the first level of disaster responders (4)? what determines the degree of attention and resources? what occurs if the resources and capabilities are overwhelmed? What is the National Response Framework (2)? (Rest, read over)

o The first level of disaster response occurs at the local level with the mobilization of responders such as the fire department, law enforcement, public health, and emergency services. - The more destruction and lives at risk, the greater is the degree of attention and resources provided at the local, regional, and state levels. - When the state resources and capabilities are overwhelmed, governors may request federal assistance under a presidential disaster or emergency declaration - National response framework (NRF), includes the ESFS - Once a federal emergency has been declared, the National Response Framework (NRF) may take effect, depending on the specific needs arising from the disaster. - The NRF focuses on response and short-term recovery and is seemingly less cumbersome to use than the NRP. - This framework "helps define the roles, responsibilities, and relationships critical to effective emergency planning, preparedness, and response to any emergency or disaster" - It is built on these five principles: engaged partnerships; tiered response; scalable, flexible, and adaptable operational capabilities; unity of effort through unified command; and readiness to act.