Disasters/Emergency Preparedness Environmental Health

Ch. 9 & 17

Defining Disasters

Any natural or human-made incident that causes disruption, destruction, or devastation requiring external assistance.

• Type and timing predict subsequent injuries and illnesses.

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• 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.

Disaster Events

• Range from affecting individuals to entire communities

• Continue to rise worldwide

• Disproportionately strike at-risk individuals

• Consistently more costly to recover from

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• 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.

Factors Contributing to the Potential for Disaster

Epidemiologic triad

• Host Factors:

  • Age, general health, mobility, psychological factors, and even socioeconomic factors

• Agent Factors:

  • Natural or technologic element that causes the disaster

• Environment Factors:

  • Those that could potentially contribute to or mitigate a disaster

Characteristics of Disasters: Scope

Range of its effect, either geographically or in terms of the number of victims.

Characteristics of Disasters: Intensity

The level of destruction and devastation it causes.

Victims of Disasters

Direct Victims: people experiencing event; dead and survivors

• Displaced persons: forced to leave to escape effects of disaster; usually temporary

• Refugees: people forced to leave homeland due to war or persecution

Indirect Victims: relatives or friends of direct victims

What are the 4 Phases of a Disaster?

1. Prevention or Mitigation

2. Preparedness

3. Response

4. Recovery

Phase 1: Prevention (Mitigation & Protection)

Prevention:

• No disaster expected or anticipated

• To identify community risk factors and to develop and implement programs to prevent disasters from occurring

Prevention Against Natural Disasters:

* 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.

• Structural measures

  • Protecting buildings and infrastructure

  • Threats include forces of wind and water

• Nonstructural measures

  • Land development restrictions

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

• Masking/social distancing

Phase 2: Preparedness

Personal Preparedness:

• Disaster kits for home, workplace, and car

Professional Preparedness:

• National Disaster Medical System (NDMS)

• Medical Reserve Corps (MRC)

• Community Emergency Response Team (CERT)

Community preparedness (Drills, plans)

Phase 3: Response

• Occurs immediately after the onset of the disastrous event and during the emergency.

• Put plans into action to save lives and prevent further damage.

• Rescue, triage, on-site stabilization, transportation of victims, and treatment at local hospitals.

Phase 3: Response—Additional Info.

• First level: First Responders

  • Mobilization of local responders

  • Fire department, law enforcement, public health, and emergency services

• 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)

Phase 3: Response—Triage

Tags: (in order of priority)

1. Red—Immediate: Chest wounds, shock, open fractures, 2-3 burns, etc.

2. Yellow—Delayed: Stable abdominal wound, eyes and CNS injuries, etc.

3. Green—Minimal: Minor burns, minor fractures, minor bleeding, etc.

4. Black—Expectant: Unresponsive, high SCI. etc.

**Know what each of the colors represent, in terms of the patient’s status

Phase 4: Recovery

• 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

• Hardest part of a disaster

• Federal assistance: (FEMA)

  • Rebuilding and restoring after large-scale event

• Gradual shift in support:

  • From short-term aid to long-term support for communities: sustainment of effort

Community’s Stress Reactions

Stress reactions in individuals:

• Exacerbation of a chronic disease/illness

• Older adult’s reactions dependent on health, independence, income, and so on…

• Regressive behaviors in children

Role of the CHN

Preventing Disasters:

• Primary level, Secondary level, and Tertiary level

Preparing for Disasters (Primary Prevention):

• Disaster planning; personal preparation; assessment for risk factors and disaster history

• Establishing authority, communication, and transportation

• Mobilizing, warning, and evacuating

Responding to disasters (Secondary prevention):

• Rescue

• Triage immediate treatment and support

• Care of bodies; family notification

Supporting recovery (Tertiary prevention):

• Long-term treatment

• Long-term support

• Need for self-care (critical incident stress debriefing [CISD])

Terrorism is…

Unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives (U.S. FBI)

• Agents for terrorism:

  • Bioweapons (mustard gas, sarin and VX gas, anthrax)

  • Nuclear agents

  • Chemical warfare

Factors Contributing to Terrorism

International Terrorism: political factors

• Anti-American sentiment

• Anti-Western sentiment

Domestic Terrorism: extremist views

• Social

• Environmental

• Racial

• Political

• Religious

Trauma From the Warfront

Traumatic Brain Injury (TBI):

• Characteristic injury of the Iraq and Afghanistan wars

• Most common causes: blast, object hitting head, falls

• Associated with: depression, PTSD, suicidal ideation

Important for C/PHNs to assess for in veterans

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

Ecology, the Human and the Environment

• Ecology is the study of the interactions and relationships between living organisms and their environments.

• Ecosystems are dynamic communities that no organism including humans can exist outside of.

• The scientific study of ecosystems provides an understanding of the relationship between humans and the environment and why knowledge of environmental health is so important for nurses.

Environmental Health

The purpose of environmental health is to ensure the conditions of human health and provide healthy environments for people to live, work, and play.

• Accomplished through…

  • Risk assessment

  • Prevention

  • Intervention

Using Critical Theory Approach

• Uses “thinking upstream” framework.

• Raises questions about oppressive situations.

• Involves community members in the definition and solution of problems.

• Facilitates interventions that reduce health-damaging effects of environments.

• Asks critical questions about clients’ work and home environments to help discern the contributions of specific hazards to health.

Benefits of an Environmental Health History

• Increased awareness of environmental/occupational factors

• Improved timelines and accuracy of diagnosis

• Prevents disease and aggravation of conditions

• Identifies potential work-related environmental hazards and/or environmental hazards in and around clients’ homes

I PREPARE: Environmental Exposure History

• I  –  Investigate potential exposures

• P – Present work

• R – Residence

• E – Environmental concerns

• P – Past work

• A – Activities

• R – Referrals and Resources

• E – Educate

**Remember what each of the letters stands for!

Areas of Environmental Health

• Built environment (man-made)

• Work-related exposures

• Outdoor air quality

• Healthy homes

• Water quality

• Food, safety, and waste management

Major Global Environmental Concerns: Overpopulation

• Effects: food scarcity, water shortages, and depletion of other vital resources

• Demographic entrapment: population > ability of ecosystem to support it or acquire needed support or when population exceeds its ability to migrate to other ecosystems in a manner to preserve its standard of living

• Government’s role: solutions possibly controversial depending on culture, religious beliefs, personal values, and convictions

• Nurse’s role: teaching about birth spacing, preventing high-risk pregnancies, preventing growing epidemic of HIV/AIDS, providing family planning education, and providing prenatal care

Major Global Environmental Concerns: Air Pollution

• One of the most hazardous sources of chemical contamination; adverse effects including costs to property, productivity, quality of life, and human life

• Difficulty establishing actual cause and effect

• Certain geographic areas more susceptible to ill effects due to weather or physical terrain

Major Global Environmental Concerns: Dusts, gases, and naturally occurring elements + Acid precipitation

• Dusts—silica dust, asbestos; gases—sulfur oxides, nitrogen oxides, chlorine, ozone, sulfur dioxide, carbon monoxide; naturally occurring elements— radon Pollen, volcanic ash, and airborne microorganisms

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• Air contaminants + precipitation = sulfuric and nitric acid (acid rain)

  • Effects: killing small life forms; danger to forest and freshwater ecologies

Major Global Environmental Concerns: Ozone Depletion + Global Warming

• Effects: increased risk for skin cancer and cataracts; indirectly damaging food chain, increasing exposure to vector-borne diseases, raising of ocean levels, and negative impact on crop production

• Government’s role: clean air legislation, reduction of greenhouse gases

• Nurse’s role: detection, community education, and lobbying for appropriate legislation

Major Global Environmental Concerns: Water Pollution

• Surface water (lakes and streams); underground sources

• Effects: cause of disease; contamination of streams, lakes, and wells; contamination of fish; and upset of ecosystem

• Government’s role: legislation for water quality testing; groundwater protection

• Nurse’s role: examining household or city drinking water, identifying increased incidences of water-related diseases, and promoting safe healthy water

Major Global Environmental Concerns: Deforestation, Wetlands Destruction, and Desertification

• Effects: upset of ecosystem; gases contributing to ozone depletion; geographic changes/landslides; drought, famine, and starvation

• Government’s role: saving wetlands and forests

• Nurse’s role: acting as a voice at the local level; leading and collaborating to initiate grassroots efforts to save wetlands and forests

Major Global Environmental Concerns: Energy Depletion

• Nonrenewable sources primarily used today; nuclear energy still controversial, including building of plant and disposal of nuclear waste

• Government’s role: discovery, rediscovery, or tapping of other renewable sources of energy; use of environmentally friendly sources

• Nurse’s role: education about energy conservation, alternative energy sources; encouragement to become interested in and knowledgeable about potential energy depletion

Major Global Environmental Concerns: Unhealthy or Contaminated Food

• Inherently harmful foods, contaminated foods, and foods with toxic additives

• Food irradiation/cold pasteurization—for global food safety

• Government’s role: regulatory agencies and monitoring

• Nurse’s role: education about proper food storage, cooking, and handling

Major Global Environmental Concerns: Waste Disposal

• Issues involving disposal of human waste, garbage, and hazardous waste

• Government’s role: establishment of standards for safe waste disposal; monitoring and enforcing compliance

• Nurse’s role: educating public and lobbying for enabling legislation; encouraging use of recyclable products; avoiding use of aerosol sprays, plastics, and other non-recyclable items

Major Global Environmental Concerns: Insect & Rodent Control

• Effects: irritation/discomfort; direct threat to health via attack; contamination of food; vectors for disease transmission (mosquitoes, flies, ticks, roaches, fleas, rats, mice, and ground squirrels)

• Government’s role: vector surveys, research, control; community awareness; and pest control programs

• Nurse’s role: increasing awareness of threat; remaining alert to evidence of insects/rodents; educating persons; notifying proper authorities; surveying communities; and influencing policy makers

Major Global Environmental Concerns: Safety in Home, Worksite, and Community

• Exposure to toxic chemicals, radiation, noise pollution, biologic pollutants; injury hazards; and psychological hazards

• Government’s role: standards and regulation; monitoring of chemical use and production; public education and community safety programs

• Nurse’s role: monitoring; preventive measures for injuries; safety education; promotion of first-aid/CPR; noise education; active lobbying for crime prevention, reduction of workplace stressors, and development of educational and support programs

Critical Community Health Nursing Practice

• Approach environmental health at the population level

• Take a stand; advocate for change

• Ask critical questions

• Facilitate community involvement

• Form coalitions

• Using collective strategies  

Alliance of Nurses for Healthy Environments (ANHE)

The Mission of ANHE:

• Promoting healthy people and healthy environments by educating and leading the nursing profession, advancing research, incorporating evidence-based practice, and influencing policy.

Strategies for Nursing Action in Environmental Health

• Learn about possible environmental health threats.

• Assess clients’ environment and detect health hazards.

• Plan collaboratively with citizens and other professionals to devise protective and preventive strategies.

• Assist with the implementation of programs.

• Take action to correct situations in which health hazards exist.

• Educate consumers and assist them to practice preventive measures.

• Take action to promote the development of policies and legislation that enhance consumer protection and promote a healthier environment.

• Assist with and promote program evaluation to determine the effectiveness of environmental health efforts.

• Apply environmentally related research findings and participate in nursing research.

B. Heat exhaustion

Which is an individual health consequence during an extreme high temperature condition?

A. Adequate hydration

B. Heat exhaustion

C. Hyperactivity

D. Uncontrollable chills