Chapter 1: Essentials Of Disaster Planning
NURSES
All___________ should have an awareness of the basic life cycle of disasters, the health consequences associated with the major events, and a framework to support the necessary assessment and response efforts.
EVALUATING CAPACITY TO RESPOND
EVALUATING CAPACITY TO RESPOND
Turn Around, Don't Drown! Never drive through flooded areas. As little as six inches of water can cause you to lose control of your vehicle. 1. Make communication plan 2. Stay informed. 3. Inform local authorities about special needs (bedridden, elderly, or with disability) 4. For homes - check hazard places, turn off electricity power, prepare emergency kits, food and water 5. If need to evacuate be prepared
FLOOD PREPAREDNESS
3. coordination why? To ensure effective medical and public health response
Leadership responsibilities and c_________ of all rescue efforts (across territories and jurisdictions) should be worked out in advance of any event.
• Determining a community's risk of adverse health effects due to a specified disaster (i.e., traumatic deaths and injuries following an earthquake) • Identifying the major hazards facing the community and their sources (i.e., earthquakes, floods, industrial accidents) • Identifying those sections of the community most likely to be affected by a particular hazard (i.e., individuals living in or near floodplains) • Determining existing measures and resources that reduce the impact of a given hazard (i.e., building codes and regulations for earthquake mitigation) • Determining areas that require strengthening to prevent or mitigate the effects of the hazar
MAJOR OBJECTIVES OF RISK ASSESSMENT
a. hazard identification and planning b. vulnerability analysis c. risk assessment d. risk assessment
Methods of data collection for disaster planning
3. Activities must go beyond the routine.
Most disasters cannot be managed merely by mobilizing more equipment, personnel, and supplies
PROFESSIONAL MANDATE
PROFESSIONAL MANDATE
natural disasters
a category of disaster that refers to those caused by natural or environmental forces intersection of a natural hazard and human activity.
1. communication 2. infomation management 3. coordination 4. Advanced warning systems and the use of evacuation 5. surge management
common CHALLENGES associated with disaster situation
5. Identify leadership and command post
The process of disaster planning is important to establishing relationships, ✓ identifying leaders and laying the groundwork for smooth responses. ✓ Identification of the command post must also be decided in advance and communicated to all members of the organization
hazard
______ is a POTENTIAL THREAT to humans and their welfare
1. complex emergencies 2. technological disasters 3. 3. not caused by natural hazards but occur in human settlements
3 CATEGORIES of man-made disasters
1. pre-impact 2. impact 3. post-impact actions taken in each phase will affect the extent of the illness
3 MAJOR PHASES of the disaster continuum why is this important
1. RECOGNIZE a potential outbreak is occurring 2. INVESTIGATE chain of infection 3. IMPLEMENT control measures
3 STEPS in managing a communicable disease outbreak 1. recognize 2. investigate 3. implement
1. alert phase 2. response phase 3. expanded response phase
3 phases of hospital incident management system
1. pre-impact (before)
A major phase of the EMC • Advance planning • Community participation - Mock drill - Mass education - Safety measures • Time factor • Coordination
agent-specific approach
focused their preparedness activities on the most likely threats to occur based on their geographic location (e.g., hurricanes in Florida)
Comprehensive Preparedness Guide 101: Developing and Maintaining Emergency Operations Plans, Version 2.0
guidelines FEMA published for all=hazards preparedness planning
1. onset 2. impact 3. duration why is this important? For example, earthquakes and tornadoes are rapid-onset events—short durations but with a sudden impact on communities. Hurricanes and volcanic eruptions have a sudden impact on a community; however, advanced warnings are issued enabling planners to implement evacuation and early response plans. A bioterrorism attack may be sudden and unanticipated and have a rapid and prolonged impact on a community
how are disasters CATEGORIZED 1. O____ 2. I______ 3. D______
2. information management
one of the challenges during a disaster situation wherein disaster plans should be portable and shared easily across the health care setting
synergystic disaster it is important to know this becaue disasters can occur simultaneously as a result of a previous or recent disaster (see secondary disaster)
other term for NA-TECH disaster (natural and technological)
vulnerable
"capable of being physically or emotionally wounded, open to attack or damage"
disaster response / emergency management
the organization of activities that is performed during the RESPONSE phase
mass casualty incidents - motor incidents -flooding -earthquake -armed conflicts
what should disaster planning address? MCI
enhancement of local community capacity to RESPOND
what type of disaster prevention measure is this - ex. healthcare coordination in the community such as hospitals, health departments, clinics, home care agencies
prevention or removal of a hazard
what type of disaster prevention measure is this - ex. closing down an aging industrial facility that did not pass the safety standard
containment of a hazard
what type of disaster prevention measure is this - ex. enforcing strict building regulations in an earthquake -prone zone,
removal of at risk populations
what type of disaster prevention measure is this evacuation of people prior to impact of an hazard events, resettling communities
mitigation of vulnerabilities
what type of disaster prevention measure is this ex. sensors to check food, water, currency, mail for contamination
establishment of an early warning system
what type of disaster prevention measure is this ex. using satellite data for information to public warnings
provision of public information and education
what type of disaster prevention measure is this providing information that can help in health measures and protection
c. human events
what type of hazard? Economic failures General strikes Terrorism (e.g., ecological, cyber, nuclear, biological, chemical) Sabotage, bombs Hostage situation Civil unrest Enemy attack Arson Mass hysteria/panic
e. context hazards
what type of hazard? climate change Sea level rise Deforestation Loss of natural resources Intensive urbanization Catastrophic earth changes
d. special events
what type of hazard? mass gatherings, concerts, sporting events, political gatherings
1. agent-specific approach 2. all-hazards approach
2 major types of DISASTER PLANS
ALL HAZARDS PLANNING page 10
ALL HAZARDS PLANNING page 10
DEFINITION AND CLASSIFICATION OF A DISASTER
DEFINITION AND CLASSIFICATION OF A DISASTER
DISASTER PLANNING page 10
DISASTER PLANNING page 10
DISASTER PLANNING AND PUBLIC HEALTH PREPAREDNESS page 10
DISASTER PLANNING AND PUBLIC HEALTH PREPAREDNESS page 10
DISASTER PREVENTION MEASURES
DISASTER PREVENTION MEASURES
DISASTERS WITHIN HOSPITALS
DISASTERS WITHIN HOSPITALS
psychological, emotional, and social well-being
Disasters may affect the _______________ of the population in the affected community. Depending on the specific nature of the disaster, responses may be fear, anxiety, depression, widespread panic, terror, and exacerbation of preexisting mental health problems. Children, in particular, may be deeply affected by the impact of a disaster
man-made natural
Disasters may be classified into two broad categories: 1. m______ 2. n_________
large population movements (refugees)
Disasters may cause _______ creating a burden on other healthcare systems and communities. Displaced populations and their host communities are at increased risk of communicable diseases and the health consequences of crowded living conditions
food
Disasters may cause shortages of ____ and cause severe nutritional deficiencies.
8. State and federal assistance
Groups and organizations are most helpful when they understand their own capabilities and limitations, as well as those of the organizations with which interactions are anticpated or intended
HAZARD IDENTIFICATION, VULNERABILITY AALYSIS, AND RISK ASSESSMENT page 12
HAZARD IDENTIFICATION, VULNERABILITY AALYSIS, AND RISK ASSESSMENT page 12
HEALTH EFFECTS OF DISASTERS page 7
HEALTH EFFECTS OF DISASTERS page 7
■ Provision of a caring relationship that facilitates health and healing. ■ Attention to the range of human experiences and responses to health and illness within the physical and social environments. ■ Integration of objective data with knowledge gained from an appreciation of the patient or group's subjective experience. ■ Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking. ■ Advancement of professional nursing knowledge through scholarly inquiry. ■ Influence on social and public policy to promote social justice
Six essential features of professional nursing (ANA, 2003, pp. 1-5):
THE DISASTER CONTINUUM page 8
THE DISASTER CONTINUUM page 8
TYPES OF HAZARD ANALYSIS
TYPES OF HAZARD ANALYSIS
American Nurse's Association (ANA)
according to ___________________ "the aim of nursing actions is to assist patients, families and communities to improve, correct or adjust to physical, emotional, psychosocial, spiritual, cultural, and environmental conditions for which they seek help."
hospital incident management system
address the institution's response to any potential incident that would disrupt hospital functioning tip: HIMS
chronic genesis or gradual onset
aka creeping disasters example of this is drought and famine because there is a gradual onset, but have a prolonged impact
yes, it can, but the other cannot cause or preclude the other
can internal and external disasters occur simultaneously?
1. earthquake 2. flood 3. tsunami 4. hurricane 5. volcanic eruption 6. ice storms 7. tornadoes
examples of natural disasters include 1. e 2. f 3. t 4. h 5. v 6. i 7. t
1. nature of the event 2. time and day of the year 3. health and age characteristics of a population 4. availability of resources
factors that influence the IMPACT of a disaster 1. n 2. t 3. h 4. a
addresses the problems posed b various potential events
effective disaster planning ___________
1. inclusion of individuals involved in the response and critique >> representation from >>>>health care disciplines >>>> government officials >>>> school officials >>>> media 2. debriefing with the participants
essential feature of disaster drills
a gas station exploding after an earthquake
examples of a secondary disaster situation
1. biologic and biochemical terrorism 2. chemical spills 3. radiologic events 4. fire 5. explosions 6. transportation accidents 7. acts of war
examples of anthropogenic disasters 1. b 2. c 3. r 4. f 5. e 6. t 7. a
c. risk assessment risk= HAZARD X VULERABILITY
uses the results of the hazard identification and vulnerability analysis to determine the probability of a specified outcome from a given hazard that affects a community with known vulnerabilities and coping mechanisms identify groups of people at particular risk of injury or death from each individual hazard
1. resource identification 2. assembling list of health care facilities 3. resource availability 4. identification and mobilization of human resources 5. coordination to agencies to avoid chaos
what are the things we need to know when we EVALUATE the capacity to respond R-A-R-C-C
a. natural events b. technological events c. human events d. special events e. content hazards
what are the types of hazard analysis
1. supplemental 2. personnel 3. equipment 4. supplies
what are the types of resources
rehabilitation and reconstruction reconstruction= rebuild damaged buildings rehabilitation=
what is done during the RECOVERY phase
US National Preparedness Goal
"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" this is the goal of what?
forecasting aka warning
______ refers to monitoring events to look for indicators that predict the location, timing, and magnitude of future disasters
evaluation phase why? to determine what worked what did not work
_______ is the phase of disaster planning and response that often receives the least attention.
preparedness
_______ refers to the proactive planning efforts designed to structure the disaster response prior to its occurrence.
disaster
________ is a catastrophic event that results in casualties that overwhelm the healthcare resources in that community
3. expanded response phase
what phase of HIMS when additional personnel are required, off-duty staff are called in, and existing staff may be reassigned based on patient's needs.
reduction of risk posed by some hazards
what type of disaster prevention measure is this - ex. relocating a chemical depot away from the community
6. Design a local response for the first 72 hours local organizational leader + executives from each agency >initial assessment (risk, hazard and vulnerability) > coordinated processes > communication systems > create standard criteria for assessment of the scope of damage
- A plan for the mobilization of local authorities, personnel, facilities, equipment, and supplies for the initial postimpact 72-hour period is composed of the next level of the foundation of the disaster response who are involved?
9. Identification of training and educational needs, resources, and personal protective equipment
9. Identification of training and educational needs, resources, and personal protective equipment
7. Identification and accommodation of vulnerable populations-
A community disaster plan must accommodate the needs of all people, including patients residing in hospitals and long-term care facilities such as nursing homes, assisted living, psychiatric care facilities, and rehabilitation centers
surge / surge management why? knowing how to manage the sudden surge or increase of patients would prevent a disaster since the equation for diasa ter DISASTER= need > available resources
A comprehensive disaster plan will account for a sudden unanticipated ____________ of patients, the effective triage of patients (prioritization for care and transport of patients), and distribution of patients to hospitals (a coordinated, even distribution of patients to several hospitals as opposed to delivering most of the patients to the closest hospital)
2. impact (during)
A major phase of the EMC • Establish emergency communication • Deploy rescue teams • Medical support & other life-saving activities. • Supply/air dropping of food, drinking water and essential items
disaster planning
Assessment of the preparedness and capacity of each hospital to respond to and treat victims of an infectious disease outbreak or biological incident must be conducted as part of ____________ ____________
BIOTERRORISM / COMMUNICABLE DISEASES
BIOTERRORISM/ COMMUNICABLE DISEASES
CORE PREPAREDNESS ACTIVITIES
CORE PREPAREDNESS ACTIVITIES
professional nursing
Caring for patients and the opportunity to save lives is what P___________ N______ is all about, and disaster events provide nurses with an opportunity to do both.
location earthquake in a low populated area= no people and housing would be damaged therefore it CANNOT be considered a disaster earthquake in a desnsely populated area= more damages = DISASTER
Defining an event as a disaster also depends on the ________ in which it occurs, particularly the population density of that location. why is this important?
premature deaths, illnesses, and injuries
Disasters may cause ____________ in the affected community, generally exceeding the capacity of the local healthcare system.
environmental imbalances
Disasters may create _________, increasing the risk of communicable diseases and environmental air, soil, and water hazards
healthcare infrastructure
Disasters may destroy the local __________, which therefore will be unable to respond to the emergency. Disruption of routine health and mental healthcare services and prevention initiatives may lead to long-term consequences in health outcomes in terms of increased morbidity and mortality.
Drop, cover, and hold on during your earthquake drill. • DROP down onto your hands and knees immediately. This position protects you from falling but still allows you to move if necessary. • COVER your head and neck (and your entire body if possible) underneath a sturdy table or desk. If there is no shelter nearby, get down near an interior wall or next to low-lying furniture that won't fall on you, and cover your head and neck with your arms and hands. Try to stay clear of windows or glass that could shatter or objects that could fall on you. • HOLD ON to your shelter (or to your head and neck) until the shaking stops. Be prepared to move with your shelter if the shaking shifts it around.
EARTHQUAKE PREPAREDNESS
EMERGENCY MANAGEMENT CYCLE
EMERGENCY MANAGEMENT CYCLE
secondary disaster
Frequently, natural and human-made disasters trigger each other and the distinctions between the two disaster types may be blurred. A natural and human-generated disaster may trigger a s__________ d_________ r, the result of weaknesses in the human environment
health healthcare human services
Healthcare providers characterize disasters by what they do to people consequences on ________, __________, _______
Tsunamis, also known as seismic sea waves, are a series of enormous waves created by an underwater disturbance such as an earthquake, landslide, volcanic eruption, or meteorite. A tsunami can strike anywhere along coastline. 1. Flood waters can pose health risks such as contaminated water and food 2.Loss of shelter leaves people vulnerable to exposure to insects, heat, cold. 3. Traumatic injuries is present due to washed debris (houses, trees, buildings etc.) 4. Surveying and monitoring for infectious people from water or insect transmitted diseases, medicine supplies, restoring primary health services, water, food, shelter, and employment
TSUNAMI DISASTER PLAN
1. preparedness 2. mitigation 3. response 4. recovery 5. evaluation
The basic phases or "life cycle" of a disaster management program include p m r r e
2. Disaster planning is only as effective as the assumptions upon which it is based.
The effectiveness of planning is enhanced when it is based on information that has been empirically verified by systematic field or research bod
"disaster continuum," or "emergency management cycle.
The life cycle of a disaster is generally referred to as the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
United States, the J___________ C__________ O_____ A___________ O___ H___________ O_________ requires that all hospitals have comprehensive plans for both internal and external disasters They created the International patient Safety Goals IPSG) to be a guideline in hospital accreditation
Volcanoes can produce ash, toxic gases, flash floods of hot water and debris called lahars, lava flows, and fast-moving flows of hot gases and debris called pyroclastic flows. Some dangers from volcanoes can be predicted ahead of time while others may occur with little or no notice after an eruption. Each volcano and situation is unique. 1.Emergency kit 2. If to evacuate - follow authorities' instructions, take only essentials with you a 1 week supply including meds if you have 3. Keep listen to radio to be updated
VOLCANIC ERUPTION DISASTER PLAN
disaster
________ is defined as: "a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts"
1. communication alternative communication tools 1. texting 2. social media
_________ is a crucial aspects of emergency management to relay information throughout different people during a disaster
mapping
_________ is done using aerial photography, satellite imagery, remote sensing, and geographic information systems
response phase
_________ phase is the actual implementation of the disaster plan focuses primarily on emergency relief: 1. saving lives, 2. providing first aid, 3. minimizing and restoring damaged systems such as communications and transportation, and providing care and basic life requirements to victims
Prevention phase
__________ refers to a broad range of activities, such as attempts to prevent a disaster from occurring, and any actions taken to prevent further disease, disability, or loss of life.
Patient evacuation and tracking
___________ during disasters is a major challenge because of lack of interoperable registration systems at shelters, and hospital communication systems that do not interface with other hospitals or county health departments. Family reunification has persisted as a major challenge to meaningful recovery initiatives. aka tracking patients
1. Prepare a theoretical foundation for disaster planning disaster plan= focuses on local response + what people are likely to do + flexibility
___________ this should be constructed. A firm foundation grounded in an understanding of human behavior. WHY?
a. Hazard Identification how is data collected: 1. Historical data 2. data about potential hazards
____________ is used to IDENTIFY which events are most likely to affect a community and to make decisions about whom or what to protect as the basis of establishing measures for prevention, mitigation, and response
4. Advanced warning systems and the use of evacuation example: 1. emergency alert system
_____________ from areas of danger save lives and should be included in community disaster response plans whenever appropriate important for disseminating warning that a disaster would occur
disaster drills
_______________ __________ provide an excellent means of testing plans for their completeness and effectiveness. ____________ __________ can be staged as large, full-scale exercises, using mock victims, and requiring vast resources of supplies and personnel, or they may be limited to a small segment of the disaster response
4. Community needs assessment.
________________ must be conducted to identify the preexisting prevalence of disease and to identify those high-risk, high-need patients that may NEED to be transported in the event of an evacuation or whose needs may necessitate the provision of care in nontraditional sites.
periodic evaluations
________________ of disaster plans are essential to ensure that personnel are adequately familiar with their roles in disaster situations, as well as to accommodate changes in population demographics, regional emergency response oprations, hospital renovations and closings, and other variable
b. Technological and accidental hazards
________________ such as dam failures or chemical substance spills or releases, have the potential to cause extensive fatalities and severe economic impacts, and the likelihood of occurrence may increase due to aging infrastructure
internal disaster tip: disaster within the hospital examples power failures, flood, water loss, chemical accidents and fumes, radiation accidents, fire, explosion, violence, bomb threats, loss of telecommunications (inability to communicate with staff), and elevator emergencies.
_________cause disruption of normal hospital function due to injuries or deaths of hospital personnel or damage to the facility itself, as with a hospital fire, power
Man-made disaster
a category of disaster that refers to human generated disaster principal direct causes are identifiable human actions, deliberate or otherwise
to ensure that nurses are aware of and prepared to deal with whatever these numerous other factors may turn out to be
as a nurse, why is it important for us to participate in all the phases of disaster planning?
external disaster tip: disaster occuring outside of the hospital
classification of hospital disaster that do not affect the hospital infrastructure but tax hospital resources due to numbers of patients or types of injuries (Burstein, 2014). For example, a tornado that produced numerous injuries and deaths in a community would be considered an ________disaster
1. internal disasters 2. external disasters
how does HOSPITALS classify disasters 1. I 2. e
1. healthcare infrastructure destruction 2. environmental imbalance 3. physical, emotional, social well-being 4. shortages of food 5. large population movements 6. premature, death, and illness
how does disasters affect the health status of the community 1. h_____ i______ 2. e______ i_____ 3. p____, e____, s_____ 4. s_____ 5. l_____ p_____ m___ 6.p_____
a calculation model for risk, where an INVENTORY/ LIST is created - existing and potential dangers -health consequences
importance of risk assessment
we would know/ predict -who will and are most likely be affected -what settlement is most likely to damage
importance of vulnerability analysis
mitigation phase
includes measures taken to reduce the harmful effects of a disaster by attempting to limit its impact on human health, community function, and economic infrastructure steps that are taken to LESSEN the impact of a disaster should one occur and can be considered as prevention measures
a. natural hazards
including hurricanes, earthquakes, wildfires, and floods—present a significant and varied risk across the country what type of hazard are these
■ loss of power, including auxiliary power ■ loss of medical gases. ■ loss of water and/or water pressure. ■ loss of compressed air and vacuum (suction). ■ loss of telecommunications systems. ■ loss of information technology systems ■ threats to the safety of patients and staff (violence, terrorism, and bombs) ■ toxic exposures involving fumes, chemicals, or radiation. ■ immediate evacuation of all patients and personnel.
internal disaster plans must address all potential scenarios including:
complex emergencies
involve situations where populations suffer significant casualties as a result of war, civil strife, or other political conflict
All-hazards approach
is a conceptual model for disaster preparedness recommended by FEMA that incorporates disaster management components that are CONSISTENT ACROSS ALL TYES OF DISASTER events to maximize resources, expenditures, and planning efforts.
Risk
is the ACTUAL EXPOSURE of something of human value and is often measured as the product of probability and loss
b. vulnerability analysis data: 1. susceptibility of individuals, property, environment
is used to determine who is most likely to be affected, the property most likely to be damaged or destroyed, and the capacity of the community to deal with the effects of the disaster
Technological disaster = disaster in technology present in the community
large numbers of PEOPLE, PROPERTY, community INFRASTRUTURE, and economic welfare are directly and adversely affected by major industrial accidents, unplanned release of nuclear energy, and fires or explosions from hazardous substances such as fuel, chemicals, or nuclear materials.
critique
the ____________ should consider comments from everyone involved in the drill. Disaster planners should review all observations and comments and respond with modifications of the disaster plan
recovery phase
this phase focuses on actions focus on stabilizing and returning the community (or an organization) to normal (its preimpact or improved status)
EMERGENCY MANAGEMENT OPERATION PLAN or comprehensive disaster
what is the END PRODUCT of the disaster planning
Build Back Better to build a resilient and sustainable community
what is the GOAL of the RECOVERY phase
it will be successful if it is 1. clear 2. specific 3. simple to understand 4. incident command system is used 5. updated
what makes disaster plans successful?
1. alert phase
what phase of HIMS during which staff remain at their regular positions, service provision is uninterrupted, and faculty and staff await further instructions from their supervisors.
2. response phase
what phase of HIMS during which designated staff report to supervisors or the command post for instructions, the response plan is activated, and nonessential services are suspended.
3. post-impact (after)
• Medical care • Food, clothing and shelter for rescued people • Disposal of bodies/animal carcasses, • prevention of epidemics • Repair and restoration of essential • services/infrastructure • Estimating loss of life and property
10. Plan for the early conduct of damage assessment. In emergency medical care, response time is important
✓ Disaster response is the early conduct of a proper damage assessment to identify urgent needs and to determine relief priorities for an affected population (Lilibridge, Noji, & Burkle, 1992).
