Community Exam 3: Ch. 25 Disaster (10 ?'s)
Include assessment of how big area is affected
#'s of people Food and water available Sanitation problems or areas of risk
Role of the Public Health Nurse in Personal and Professional Preparedness:
Before a public health nurse can play a vital role in community preparedness, the nurse must accomplish the critical elements of both personal and professional preparedness.
Reinforcing infrastructures is a
structural measure against a natural disaster.
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.
The National Incident Management System (NIMS) is a
systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work together seamlessly and manage incidents involving all threats and hazards—regardless of cause, size, location, or complexity—in order to reduce loss of life, property and harm to the environment
Normal priorities change to crisis standards:
Save as many lives as possible History has shown us all too well the magnitude of disasters and devastation to responders and receivers
Psychological Stress of Disaster Workers
- Workers at risk for stress reactions - Vicarious traumatization - Degree of workers' stress depends on the nature of the disaster, their role in the disaster, individual stamina, and other environmental factors - May not recognize the need for self-care - Symptoms may signal need for stress management assistance
Agents of Bioterrorism: Tularemia:
- (rabbit fever, deer fly fever) is a zoonotic disease caused by the bacterium agent Francisella tularensis, which is carried commonly by wild animals, especially rabbits, as well as muskrats, voles, beavers, some domestic animals, and some ticks, mosquitoes, and flies. - Tularemia is not transmitted from person-to-person. 1.Commonly the onset is sudden and may resemble influenza with high fever, myalgia, headache, nausea, and chills. Ulcerative lesions appear (buboes), which can cause confusion with plague. Pneumonia is a possible complication. 2.Aminoglycosides or ciprofloxacin are the treatment drugs of choice, and there is no vaccine in use in the United States. 3.Aerosolized tularemia with resulting pneumonic disease is considered the most likely scenario for use as an agent of bioterrorism. 4. Tularemia has been reported from every state except Hawaii but is not a particularly common disease, with only 120 to 130 cases documented each year.
Agents of Bioterrorism: Plague
- A vectorborne disease transmitted by rodent fleas carrying the bacterium Yersinia pestis - Fewer than 20 cases per year since 1970 in United States - Initial signs and symptoms of plague are nonspecific and include myalgia, malaise, fever, chills, sore throat, and headache, as the disease progresses, lymphadenitis commonly develops, producing the characteristic bubo. - Bubonic (lymphadentitis) plague can progress to septicemic plague and secondary pneumonic plague, which creates human-to-human outbreaks. Untreated cases of septicemic and pneumonic plague are most often fatal, with a case fatality rate of 50% to 60%. - Streptomycin is the treatment of choice, with tetracycline and chloramphenicol as alternatives. - Immunization may confer some protection from bubonic plague, but not pneumonic. However commercial plague vaccine is no longer available in the United States. - A bioterrorism attack would most likely be aerosolized, resulting in pneumonic disease and human-to-human transmission.
Response
- Actual implementation of the plan - Activities used to address the event - Focuses on emergency relief -- Saving lives -- First aid -- Minimizing and restoring damaged systems -- Care and basic life requirements to victims --- Food --- Water --- Shelter
Disaster planning
- Addresses problems posed by various events - Broad in scope - Addresses collaboration - Mutual aid agreements -- Agencies -- Organizations
Prevention (Mitigation and Protection)
- All-hazards mitigation (prevention) -- Reducing risks to people and property from natural hazards before they occur - Prevention against natural disasters -- Structural measures --- Protecting buildings and infrastructure --- Threats include forces of wind and water - Nonstructural measures -- Land development restrictions
Local health department must be prepared to:
- Collect and analyze surveillance data - Work with local physicians, State Dept of Health and CDC to manage outbreaks - Conduct epidemiological investigations - Develop plans for NPS - Mass prophylaxis - Lab testing
Healthy People 2020
- Disaster incidents have an effect on almost every objective. - Disasters play a direct role in the objectives related to the following: -- Environmental health -- Food safety -- Immunization and infectious disease -- Mental health and mental disorders
Recovery
- Focuses on stabilization - Returning community to pre-impact status - Rehabilitation - Reconstruction - Epidemiological surveillance is needed
National Disaster Planning and Response
- Homeland Security Act of 2002- created Department of Homeland Security - Presidential Policy Directive 8 (PPD-8, 2011) provides guidance for how the nation, from the Federal level to private citizens, can prevent, protect, mitigate, respond to and recover from threats.
Support systems are vital for:
- Medical treatment and supplies. - Shelter. - Food. - Water. Prevent mortalities and morbidities as after effects of a disaster
Role of Public Health Nursing in Disaster Recovery
- Ongoing community assessment - Community resilience -- Recovery for community as whole and for person as an individual - Psychosocial support -- Possible feelings of severe hopelessness, depression, and grief in the disillusionment phase -- Referrals to mental health professionals - Phases of emotional reactions during recovery Heroic Honeymoon Disillusionment Reconstruction
Role of Clinicians
- Participate in planning and preparation for immediate response to a BT or other disaster event - Must use critical thinking skills in clinical judgment and decision making - Need to set priorities in order to ensure appropriate care for individuals, families and special groups (elderly, pregnant women, children, people with chronic conditions) - Triage, care for victims - Do appropriate lab tests, ID potential agents for BT - Call local Health Department to report BT activity - Measures to contain and control spread of infection from BT - Astute clinicians on the front line are key to early identification
Preparedness
- Proactive planning efforts - Evaluating potential vulnerabilities - Warning/looking for indicators -- Location -- Timing -- Magnitude
Outlining roles of local agencies
- Read and understand local disaster plans - Role of health department is on front line of disaster prevention - Community warning system and evacuation plans - Emergency Management Agency (EMA) coordinates with local, state, and federal agencies - Disaster and mass casualty exercises -- Provide the opportunity to test and update disaster plans -- Disaster management training through Red Cross
How Disasters Affect Communities
- Stress reactions in individuals - Exacerbation of a chronic disease - Older adult's reactions dependent on health, strength, mobility, independence, and income and so on - Regressive behaviors - Populations at greatest risk after a disaster p.518 Box 23-7 - Stress reactions in the community -- Heroic -- Honeymoon -- Disillusionment -- Reconstruction
Disaster events range from
- affecting individuals to entire communities - American Red Cross responds to a disaster in the United States every 8 minutes (over 70,000 incidents each year) - Continue to rise worldwide - Disproportionately strike at-risk individuals - Consistently more costly to recover from
Disaster management includes four stages:
- prevention (mitigation and protection) - preparedness - response - recovery.
Anthrax facts
1.Because of such factors as the ability for aerosolization, the resistance to environmental degradation, and a high fatality rate, inhalation anthrax has long been considered to have an extremely high potential for being the single greatest biological warfare threat. 2.Any threat of anthrax should be reported to the Federal Bureau of Investigation (FBI) and to local and state health departments. 3.Anthrax is sensitive to a variety of antibiotics, and immunization is available for those with exposure risk.
Disasters: Man-made:
Accidental Deliberate Biological Chemical Radiologic Explosive
The Nursing Role in Psychosocial Support:
Acute and chronic illnesses can become worse by the prolonged effects of a disaster and the psychological stress of cleanup and moving. Short-term psychological effects can eventually merge with long-term
Disaster planning address
Address needs assessment Event management Recovery efforts
Prevention (Mitigation):
All-hazards mitigation (prevention) is an emergency management term for reducing risks to people and property from natural hazards before they occur. Prevention also includes human-made hazards and the ability to deter terrorists before they strike, and take decisive action to eliminate the threat.
Disaster and Mass Casualty Exercises:
Although practice cannot ensure a perfect response to disaster, disaster and mass casualty drills and exercises (discussion-based simulations, tabletops, operations-based events such as drills, functional, and full-scale exercises) are extremely valuable components of preparedness. The lessons learned through after-action reports are used to update disaster plans and subsequent operations.
Community phases of disaster
Although the initial response phase to a disaster generally provides an onslaught of relief aid, impatience and the loss of momentum towards seeking normalcy is soon felt.
Disaster is:
An emergency of such severity and magnitude that the resultant combination of death, injury, illness, and property damage cannot be effectively managed with routine resources or procedures.
Disaster
Any natural or human-made incident that causes disruption, destruction, or devastation requiring external assistance Can include: Type and timing predict subsequent injuries and illnesses.
3 Cs of disaster response
Communication Coordination Collaboration Need to address long- and short-term effects of a disaster
Adequate disaster preparedness and response is essential
Delivery of life-saving interventions Optimization of population health outcomes
Personal preparedness
Disaster kits for home, workplace, and car Plans of where to meet, who to call in your family
Personal Preparedness:
Disasters by their nature require nurses to respond quickly, which requires that nurses plan for their own needs and the needs of their families and pets to meet their disaster obligations at work or in volunteer efforts. Additionally nurses assisting in disaster relief must be as healthy as possible, both physically and mentally. One way a nurse can feel assured about family member protection is by working with them to develop the skills and knowledge necessary for coping with a disaster.
Professional preparedness
Does your place of employment have a business continuity plan? Does your place of employment have a disaster plan? Nurses can work on teams such as: - National Disaster Medical System (NDMS) - Disaster Medical Assistance Team (DMAT) - Medical Reserve Corps (MRC) - Community Emergency Response Team (CERT)
There are 15 ESFs, and HHS is the primary agency responsible for
ESF 8- Public Health and Medical Services. - ESF 8 is coordinated by the Secretary of HHS principally through the Assistant Secretary for Preparedness and Response (ASPR). - ESF 8 resources can be activated through the Stafford Act or the Public Health Service Act.
Emergency Support Functions
ESF1 Transportation ESF2 Communications ESF3 Public Works and Engineering ESF4 Firefighting ESF5 Emergency Management ESF6 Mass Care, Housing, and Human Services ESF7 Resources Support ESF8 Public Health and Medical Services ESF9 Urban Search and Rescue ESF10 Oil and Hazardous Materials Response ESF11 Agriculture and Natural Resources ESF12 Energy ESF13 Public Safety and Security ESF14 Long-term Community Recovery and Mitigation ESF15 External Affairs
Disasters: Natural:
Earthquake Tornado Floods Hurricanes Blizzards Wild fires Tsunamis Nuclear
Professional Preparedness:
Every state needs a qualified workforce of public health nurses for solutions for today's public health problems, which include natural disasters and the threat of terrorism. Disaster management in the community is about population health and does involve the public health core functions of assessment, policy development, and assurance. However, operating in the chaos of a disaster surge demands a flexible and proficient practice base in each of the core functions and 10 essential services.
In disasters, nurses tend to be:
First receivers of injured victims. First responders to render emergency aid and triage.
Role of the Public Health Nurse
First responder Epidemiology and ongoing surveillance Rapid needs assessment Disaster communication Disaster response ethics Sheltering
Gradual shift in support
From short-term aid to long-term support for communities: sustainment of effort
Agents of Bioterrorism: Anthrax: Gastrointestinal:
Gastrointestinal anthrax has rarely been reported in the United States. Infection usually develops from 1 to 7 days after exposure.
Nursing Role in Sheltering:
General population shelters are generally the responsibility of the local Red Cross Chapter under the ESF 6 partner function. In massive disasters, mega-shelters with the capacity to house thousands may be initiated in partnership with local, regional, or state government for the masses needing temporary shelter.
How is smallpox spread?
Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Before smallpox was eradicated, it was mainly spread by direct and fairly prolonged face-to-face contact between people. Smallpox patients became contagious once the first sores appeared in their mouth and throat. - They spread the virus when they coughed or sneezed and droplets from their nose or mouth spread to other people. They remained contagious until their last smallpox scab fell off.
Prevention against human-made disasters
Heightened inspections Improved surveillance and security operations Public health and agricultural surveillance and testing Immunizations Isolation Quarantine Halting of chemical, biological, radiological, nuclear, and explosive (CBRNE) threats
Agents of Bioterrorism: Anthrax: Inhalation:
Inhalation anthrax is considered to be the most deadly form of anthrax. Infection usually develops within a week after exposure, but it can take up to 2 months
Actions taken during these phases will affect the extent of:
Injury. Illness. Death.
Emergency preparedness and disaster management (EPDM)
Lacks a true beginning or end Overarching framework is prevention Learn from past and present Analyze future possibilities
Which of the following represents a nonstructural measure against a natural disaster?
Land development restrictions
Disaster Management and Emergency Preparedness: Nursing and Disaster:
Respond quickly Clinically competent to provide safe, appropriate, individual and population-based care
Agents of Bioterrorism: Smallpox:
Last known natural case in the United States was in 1949; last known case world-wide was in 1977 If released susceptibility is 100% in the unvaccinated (those vaccinated before 1982 are not considered protected although they may have some immunity) and the fatality rate is estimated at 20% to 40% or higher. Many health care providers may not identify disease because many have not seen smallpox. Although, it is important for health care providers to be able to distinguish between smallpox and chickenpox. WHO does not recommend vaccination of the general public because currently the risk of death or serious side effects is greater than that of the disease. Vaccine available since 2007
CERT Courses are offered throughout Shelby County: Steps are:
Make a plan Build a Kit Pack a "Go Bag" Know First Aid Learn CPR CERT Training
Mitigation: What are we going to do before?
Measures taken to reduce harmful effects Preventions Occurs before incident Adjust the plan as needed
First level: first responders
Mobilization of local responders - Fire department, law enforcement, public health, and emergency services - Different agencies have different levels of responsibility
Agents of Bioterrorism: Anthrax: Cutaneous:
Most common form of anthrax infection, and is considered to be the least dangerous. Infection usually develops from 1 to 7 days after exposure.
Community Preparedness
National Health Security Strategy (NHSS) Disaster and mass casualty exercises The National Exercise Program (NEP) Homeland Security Exercise and Evaluation Program Federal Emergency Management Agency (FEMA)
The following 3 make up a national doctrine for preparedness
National Preparedness Guidelines (NPG) National Response Framework (NRF) Emergency Support Function 8 (ESF-8) Public health and Medical
Response:
National Response Framework (NRF) - Emergency support functions (ESFs) National Incident Management System (NIMS) Response to biological incidents - Biodefense programs -- BioWatch, BioSense, Project BioShield, Cities Readiness Initiative, Strategic National Stockpile (SNS)
EPDM plans:
Needed at all levels
Future of Disaster Management
Nurses continue to plan and train. -- All-hazards environment -- All specialty practices must participate. Public health nurses = critical members of disaster team -- Population-based focus -- Expertise in epidemiology and community assessment Stay current in disaster training and committed to the following: -- Community planning activities -- Exercise participation -- Actual disaster work
The Disaster Management Cycle and Nursing Role
Nurses have unique skills for all aspects of disaster to include assessment, priority setting, collaboration, and addressing both preventive and acute care needs. Additionally, public health nurses have a skill set that serves their community well in disaster to include health education and disease screening, mass clinic expertise, an ability to provide essential public health services, community resource referral and liaison work, population advocacy, psychological first aid, public health triage, and rapid needs assessment. Nurses have been serving in disasters for more than a century, and to this day, provide a significant resource to both the employee and the volunteer disaster management workforce, unmatched by any other profession.
Nursing Role in Disaster Communication:
Nurses working as members of an assessment team must return accurate information to relief managers to facilitate rapid rescue and recovery. Lack of or inaccurate information regarding the scope of the disaster and its initial effects contributes to misuse of resources. Times of crisis or great uncertainty call for great skills in communication. - The Public Information Officer (PIO) is an individual with the authority and responsibility to communicate information to the public at large, and the nurse should refer the media to the PIO representing the agency unless the information requested conveys health information that provides health education (i.e., early warning symptoms of a disease). Risk communication is the science of communicating critical information to the public in situations of high concern. The objectives in emergency communications are to identify and respond to the barriers of fear, panic, distrust, and anger; build or reestablish trust; resolve conflict; and coordinate between stakeholders so that the necessary messages can be received, understood, accepted, and acted on.
Post Event Vaccine Plan
One case in US Offer vaccine to community Twenty sites Over 200 volunteers per site / day
Roles for Community Health Nurses in Disaster Management
Participation in risk assessment Participation in community disaster planning Participation in community disaster response -- Activating the plan if needed -- Triage -- Directing disaster victims, evacuation, quarantine, -- Management of shelters -- Assessing mental health reactions, giving treatment Participation in community disaster evaluation
Volunteers
Physicians Nurses Clerical Pharmacy Crowd and traffic control Translators Information Techs Mental Health Professionals Clinical Students General volunteers (answer phones, fill out forms etc.)
Life cycle of a disaster=disaster continuum: 3 phases:
Pre-incident Trans-incident Post-incident
Key concepts of the preparedness framework:
Preparedness Response Recovery Mitigation Evaluation
Collaboration is necessary among:
Private health care. Social organizations. Community health providers. Community agencies. Population at large.
Community Preparedness:
Public health departments are upgrading and integrating the state and local public health jurisdictions' capacity to quickly and effectively prepare for and respond to bioterrorism, outbreaks of infectious disease, and other public health threats and emergencies. Mutual aid agreements establish relationships between partners before the incident at the local, regional, state, and national levels and ensure seamless service.
Nursing Role in the Ongoing Community Assessment:
Rapid needs assessment continues into and ongoing community needs assessment, because some conditions manifest after time elapses. Recovery community assessment can be more in-depth with a better sense of confidence in the results. A realistic perspective is most useful to the community recovery effort. Post disaster cleanup creates a number of opportunities for unintended injury and hazards.
Federal assistance
Rebuilding and restoring after large-scale event
Populations at greatest risk after a disaster
Seniors Vision/hearing impaired Women, children People with chronic disease, mental illness, non- English speakers Low income, homeless, tourists, people new to area Persons with disabilities Single parent families Substance abusers Undocumented residents
How do we expect a smallpox attack to occur, if one happens?
The deliberate release of smallpox as an epidemic disease is now regarded as a possibility. We can't say with certainty how an attack might occur, but we do know how smallpox is normally transmitted. Transmission most often occurs through person-to-person contact, more rarely through contact with materials contaminated with the smallpox virus, rarely through airborne contagion in enclosed settings. Because an attack could have such serious consequences, every effort is being made to prepare for such a possibility even though it is unlikely to ever occur. These preparedness efforts therefore include use of the best way to prevent smallpox: vaccination.
Nursing Role in Epidemiology and Ongoing Surveillance
The five components to a comprehensive public health response to outbreaks of illness are detecting the outbreak; determining the cause; identifying the factors that place people at risk; implementing measures to control the outbreak; and informing the medical and public communities about treatments, health consequences, and preventive measures. Ongoing assessment or surveillance reports are just as important as initial assessments. Surveillance reporting, whether initial or ongoing, addresses the status of the outbreak, effectiveness of relief efforts, and need for resources and continue into the recovery phase.
Smallpox:
These scabs and the fluid found in the patient's sores also contained the variola virus. The virus can spread through these materials or through the objects contaminated by them, such as bedding or clothing. People who cared for smallpox patients and washed their bedding or clothing had to wear gloves and take care to not get infected. Rarely, smallpox has spread through the air in enclosed settings, such as a building (airborne route). Smallpox can be spread by humans only. Scientists have no evidence that smallpox can be spread by insects or animals.
Agents of Bioterrorism: Anthrax: Injection:
This type of infection has never been reported in the United States.
Pre Event
Vaccinate First Responders - Hospital Teams - Public Health Teams *Provides staff to care for and investigate first cases
Response evaluation
What worked? What didn't? Problems Issues Challenges Quality Assurance Revisions
Developing land development restrictions is
a nonstructural measure taken to prevent a natural disaster.
In recovery, the immediate response actions
address initial consequence subside. Recovery is about returning to a new normal, a community balance of infrastructure and social welfare that is near the pre-event level, and the hardest part of a disaster. The approach to relief shifts from short-term aid to long-term support. Long-term support should allow the disaster-affected people representation in the relief effort and incorporate their knowledge and skills to prioritize use of local resources and relief assistance building on the existing community resilience.
Symptoms that may signal a need for stress management assistance include the following:
being reluctant or refusing to leave the scene until the work is finished; denying needed rest and recovery time; feelings of overriding stress and fatigue; engaging in unnecessary risk-taking activities; difficulty communicating thoughts, remembering instructions, making decisions, or concentrating; engaging in unnecessary arguments; having a limited attention span; refusing to follow orders (Bryce, 2001). Physical symptoms can also occur, such as tremors, headaches, nausea, and colds or flulike symptoms.
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.
Stress reactions-
confusion, memory loss, shock, numbness, nausea, GI issues, fear, depression, poor sleep, pain, fatigue, suspicion, irritability, withdrawal, increased smoking or substance use , poor concentration, difficulty making decisions, feeling lost, jumpiness, dizziness, tremors, grinding teeth, increased/decreased eating, excessive silence
The Emergency Management Agency (EMA) is a
coordination entity responsible for creating a comprehensive, all-hazard plan that incorporates scenarios that illustrate plausible major incidents that may affect the community providing opportunities to train, exercise, evaluate, and update the plan. Good disaster preparedness planning involves simplicity and realism with backup contingencies. The community must have an adequate warning system and evacuation plan.
Community Emergency Response Team (CERT) educates people about
disaster preparedness for hazards that may impact their area and trains them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations.
The poor, elderly, women, and children in developing countries are
excessively affected and least able to rebound. By 2050, the percentage of population areas more vulnerable to disasters will increase, with 80% of the world's population living in developing countries and 46% living in tornado and earthquake zones or near rivers and on coastlines. The cost of disaster recovery efforts has also risen sharply. In the United States, increases in population and development in areas vulnerable to natural disasters, especially coastal areas, have led to major increases in insurance payouts for every decade.
The role of the public health nurse in the recovery phase is as varied as in the previous disaster phases and requires
flexibility during community cleanup and rebuilding efforts; awareness of the potential public health challenges; and monitoring of the physical and psychosocial environment.
Emergency management is responsible for
for evolving and coordinating emergency response plans within a defined area.
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 (CBRNE) threats. Nurses within the community may be involved in many roles, such as community advocacy and public health nursing. The nurse should be familiar with the region's local cache of pharmaceuticals and how the Strategic National Stockpile (SNS) and state/local Points of Dispensing (POD) provide population prophylaxis within 48 hours. Nurses should be aware of high-risk targets and current vulnerabilities within the community, as well as the potential actions to eliminate or mitigate the vulnerability.
Priority goes to victim with
highest probability of survival.
Immunizations and quarantine are measures taken against a
human-made disaster.
A disaster is any
human-made or natural incident that causes destruction and devastation that cannot be alleviated without assistance. From a health care standpoint, the disaster event type (human-made or natural, prior or little/no warning) and timing predict subsequent injuries and illnesses. Public health disasters create pressing or competing needs across a widespread region, producing a public health surge. Can include: sudden mass casualty incidents, unfolding infectious disease outbreaks, or evolving environmental disasters
Depending on the job and possible volunteer assignments, it is expected that nurses
know how to use personal protective equipment (PPE), operate specialized equipment needed to perform specific activities, and safely perform duties in disaster environments.
Triage
is a process of separating casualties and allocating treatment based on the victim's potential for survival. Public health triage is a population-based approach for use in an incident undefined by geographic location and involves the sorting or identification of populations for priority interventions such as epidemic triage.
Agents of Bioterrorism: Anthrax
is an acute disease caused by the spore-forming bacterium Bacillus anthracis. It manifests in one of four syndromes: cutaneous, gastrointestinal, inhalation, or injection.
Emergency Support Functions (ESFs)
is the grouping of governmental and certain private sector capabilities into an organizational structure to provide support, resources, program implementation, and services that are most likely needed to save lives, protect property and the environment, restore essential services and critical infrastructure, and help victims and communities return to normal following domestic incidents.
The first level of a disaster response occurs at the
local level. If the disaster warrants significant local attention, then the county or city emergency management agency (EMA) will coordinate activities with the emergency operations center (EOC) and use mutual aid agreements for needed personnel, equipment, services, and supplies. Usually localities within a county are signatories to a regional or statewide mutual aid agreement. The more destruction and lives at risk, the greater the degree of attention and resources. When state resources and capabilities are overwhelmed, governors may request federal assistance under a presidential disaster or emergency declaration.
ESF 8 - Public Health and Medical Services provides the
mechanism for coordinated Federal assistance to supplement State, Tribal, and local resources in response to an emergency.
No CPR if
no one is coming with a higher level of care.
Environmental factors include
noise, inadequate workspace, physical danger, and stimulus overload, especially exposure to death and trauma.
Professional preparedness also requires that
nurses be aware of and understand the disaster plan at their workplace and community.
Disasters can affect
one family at a time, as in a house fire, or they can kill thousands and result in economic losses in the millions, as with floods, earthquakes, tornadoes, hurricanes, tsunamis, and bioterrorism. Disaster disproportionately strikes at-risk individuals, whether their day-to-day risk is physical, emotional, or economic.
The National Disaster Medical System (NDMS), the Disaster Medical Assistance Team (DMAT), the Medical Reserve Corps (MRC), and the Community Emergency Response Team (CERT) provide
pportunities to support emergency preparedness and response at national and local level. The American Red Cross (ARC) offers training in disaster health services and disaster mental health for local response and national deployment opportunities.
Disasters produce conditions that demand an aggregate care approach, increasing the need for
public health nursing involvement in community service during disaster and catastrophe. Disaster response teams need nurses with disaster and emergency management training, especially those who have served previously in a disaster. Although the majority of disaster work is not high-tech, the knowledge one needs for CBRNE disasters must be developed to include access to a ready cache of information related to nursing care.
Recovery is about
returning to the new normal Community balance of infrastructure and social welfare near the level that it would have had if the event had not occurred - Often hardest part of a disaster
Disasters with little or no advance notice, such as
terrorism events, will often have more casualties because those affected have little time to make evacuation preparations. Disasters with warnings also carry their own dangers, because individuals can be injured attempting to prepare for the disaster or while evacuating. Hurricanes, tornadoes tsunamis, earthquakes, fires, what else?
During the recovery phase for a large-scale incident,
the federal government provides assistance with rebuilding property, restoring lifelines, and restoring economic institutions with the assistance of individuals, the private sector, and nongovernmental entities.
The importance of being adequately trained and properly associated with an official response organization cannot be overstated. This avoids the
the role conflict, anger, frustration, helplessness, and potential injury or death of well-intentioned, but untrained and ill equipped people who inevitably come out in response to a disaster.
The NIMS is the essential foundation to the National Preparedness System (NPS) and provides
the template for the management of incidents and operations in support of all five National Planning Frameworks. The purpose of the NIMS is to provide a common approach for managing incidents
National Incident Management System (NIMS) is a
unified all discipline, all hazards approach to domestic incident management. Gives a common language and structure for all those involved in disaster response to communicate effectively and efficiently.