10. Community Preparedness--Community Nursing

All-Hazards Vulnerability Study

An integrated approach to emergency preparedness that addresses a wide spectrum of emergencies

after-action report

Retrospective analysis used to evaluate emergency response drills

decontamination

Process of cleaning to remove biologic, chemical, or radiologic agents.

human stimulation test (HST)

Use of life-like/computerized models for creating increased reality during a practice scenario

incident command system (ICS)

Common organizational structure implemented to improve emergency response

National Response Framework (NRF)

Framework that guides how the nation conducts all hazards incident response

mass casualty index (MCI)

Any incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties

medical reserve corps (MRC) or community emergency response team (CERT)

Community-based program that uses volunteers for emergency preparedness response

national incident management system (NIMS)

Structured, flexible framework that guides the response to disasters at all levels of government, the private sector, and nongovernmental organizations

Point of distribution (POD) or Emergency dispensing site (EDS)

centralized location where the public picks up emergency supplies following a disaster

real time

actual time something occurs

scenario

sequence of possible events or circumstances

simulation

The imitation of the features of an object or anticipated response

surveillance

A process to document and track changing information to prevent injury and illness

terrorism

The use of threats and/or violence to intimidate or coerce society for political purposes

weaponize

to convert into a weapon for use in harming others

disasters

an event that causes human suffering and demands more resources in the community. A disaster can be naturally occuring, man-made, or a combination of both (natural disaster causing technological failures)

Disaster preparedness includes...

planning for all types of hazards and establishing protocols for managing the surge of clients in the healthcare system

disaster classification

Type of onset

Duration of the immediate crisis

magnitude or scope of the incident

The extent to which the event affects the community

disaster management cycle

prevention (mitigation)

preparedness

response

recovery

disaster preparedness (mitigation)

activities to prevent disasters

preventing communicable disease transmission

demographics of community members

identification and assessment of population at risk

activities to prevent disasters

increasing surveillance, improving inspections and airport security, and strengthening public health processes such as immunizations, isolation, and quarantine

preventing communicable disease transmission

strengthening levees/barriers to prevent flooding and teaching methods of preventing communicable disease transmission

demographics of community members

threats, vulnerabilities, and capabilities

identification and assessment of populations at risk

Fewer resources or less of an ability to withstand and survive a disaster without physical harm

The populations tend to be physically isolated, disabled, or unable to access disaster services

disaster preparedness

What you can do immediately to be prepared

Occurs at national, state, local levels

Level of management: preparedness for natural or man-made disasters

Setting up a communication protocol is an important part of planning

Disaster drills

What you can do immediately to be prepared

Join your local MRC or CERT

Familiarize yourself with your community's Emergency Response Plan

Take the ICS Training online

Prepare your personal emergency kit evacuation kit

Personal and family preparedness are crucial components as is...

professional preparedness for employees in civil service and health care

Disaster preparedness should stem from...

threats and vulnerabilites identified in prevention level, and should coordinate community efforts as well as outline specific roles of local agencies

individual and family preparedness

create an action plan and determine alternative methods of communication, possible evacuation routes, identify local and distant meeting places, and create disaster kit

Setting up a communication protocol is an important part of planning

Should provide access to emergency agencies lile American Red Cross and state and federal governmental agencies

disaster drills

replicate possible scenarios in local area and enhance preparedness

disaster response

National Incident Management System (NIMS)

Different agencies, governmental and nongovernmental, are responsible for different levels of disaster response

Disasters classificiation

If federal emergency declared

provides structure for managing any type of disaster, incorporating various public and private agencies.

National Incident Management System (NIMS)

goal of NIMS

effective communication and clear chain of command to manage disasters

Different agencies, governmental and nongovernmental, are responsible for different levels of disaster response

Federal Emergency Management Agency (FEMA)

CDC

U.S. Department of Homeland Security (DHS)

American Red Cross (ARC)

Office of Emergency Management (OEM)

Public health system

if federal emergency is declared

National Response Framework (NRF) is activated and provides direction for an organized, effective national response

disaster recovery

- Begins when danger no longer exists and needed representatives and agencies are available to assist with rebuilding

- Recovery lasts until economic and civil life of the community are restored (days, weeks, or years)

- At an individual level, it is the time it takes an individual to become functional within a community after a disaster

- Important aspects of disaster recovery: communicable disease and sanitation controls

- Post-traumatic stress disorder (PTSD) and delayed stress reactions (DSR)

disaster response assessment

How many people are affected

How many are injured or dead

How much fresh water and food is available

What are the areas of risk or sanitation problems

Classify according to type, level, and scope

heroic reaction

intense excitement and concern for survival. Often a rush of assistance from outside the area is present

honeymoon reaction

affected individuals begin to bond and relive their experiences

disillusionment reaction

responders can experience depression and exhausation. Phase contains unexpected delays in receiving aid

reconstruction reaction

involves adjusting to a new reality and continued rebuilding of the area. Counseling is sometimes needed. Those affected begin looking ahead

mitigation

prevention process with two components

two components of mitigation

Structural mitigation and Nonstructural mitigation

Structural mitigation

involves creation or removal of structures or alteration of the environment to remove or modify risk

structural mitigation example

the installation of a generator to be used during a power failure

Nonstructural mitigation

includes disaster training for healthcare personnel, the establishment of emergency evacuation regulations, land use planning, legislation, and insurance

what does mitigation involve?

efforts to lessen the impact of a disaster by initiating measures to limit damage, disease, disability, and loss of life among the members of a community (tertiary prevention)

mitigation refers to a broad range of activities that are only accomplished satisfactorily by...

planning prior to the event

example of preventing an event (mitigation)

Trimming of trees near power lines to prevent loss of power during an incident

disaster legislation

Stafford Disaster Relief and Emergency Assistance Act

Public Law 93-288: Approved May 22, 1974

As Amended Through P.L. 118-44, Enacted March 18, 2024

H.R> 3858-Pets Evacuation and Transportation Standards Act of 2006

nurses role in planning

Develop disaster response plan

Identify community disaster warning system and communication center

Identify first responders' disaster plan

Make a list of agencies that are available for varying levels

Define the nursing roles

Identify the roles of personnel and chain of command

Locate all equipment and supplies needed

Check equipment regularly

Evaluate efficiency, response time, and safety of disaster drills, mass casualty drills, and disaster plans

Assist community members with peronal preparedness with disaster kit

what should a disaster kit have

3 days supply of food, water, meds, clothing, and hygeine, copies of personal documents, and first aid supplies

nurse's role in disaster response

Activate disaster management plan

Perform triage, direct those affected, coordinate evacuation, quarantine, and opening of shelters

Triage involves: serious vs minor injuries, prioritize victims, and transferring those requiring immediate attention

nurse's role in disaster recovery

Make home visits and reassess health care needs

provide/coordinate care in shelteres

Provide stress counseling and assess for PTSD

nurse's role in evaluation of disaster response

Evaluate area, effect, and level

Create ongoing assessment and surveillance

Efficiency of disaster response team

Estimate length of recovery time

level A personal protection

Highest protection for respiratory tract, skin, eyes, and mucous membrane protection

what does level A PPE include?

SCBA, fully encapsulated water- and vapor-proof suit with a cooling system, boots, gloves, hard hat, and a two-way communication device

level B personal protection

Highest protection for respiratory tract; skin, and eye-splash resistant protection

what does level B PPE include?

SCBA, liquid splash-resistant clothing, hood, gloves, hard hat, boots, two-way communication device

level C personal protection

Same level of protection for skin and eyes as level B, air-purifying system for respiratory tract

what does level C PPE include?

Full face, air-purifying respirator rather than SCBA, liquid splash-resistant clothing, hood, gloves, hard hat, boots, twoway communication device

level D personal protection

Standard work protection from splashes, minimal skin protection, no respiratory protection

what does level D PPE include?

Cover suits, safety glasses, gloves, boots, and face shield

evacuate

occurs when there is potential for massive explosions and fire as well as for long duration events; people must leave their homes or go to safer area

guidelines for evacuation

Wear long-sleeved shirts, long pants, and sturdy shoes

Take your pets with you

Lock your home

Take your disaster supplies kit

Use travel routes specified by local authorities: do not use shortcuts because certain areas may be impassable or dangerous

Stay away from downed power lines

invacuate

where people in a hospital or residential facility may be moved to another floor or area within the facility, may occur

shelter-in-place

used for short-duration incidents, when moving would result in a greater hazard, or it is impractical to evacuate

how often does the TJC require fire drills?

quarterly

red tag

Critical→ Unstable, requiring immediate intervention

yellow tag

Urgent→ Stable, but may deteriorate

green tag

Delayed→ Injured or ill but stable and not likely to deteriorate (walking wounded)

black tag

Expectant→ Dead or nonsalvageable given available resources

START model 0

Those who have died

START model 1

Injured, requiring immediate transfer

START model 2

Injured, who can wait to be transferred

START model 3

Injured, with minor less urgent needs

nurse's role in chemical disaster

Assess hazardous material

Identify threatened population

Evaluate time span

Assess current/predicted weather

Assure communication

High toxicity and short duration

shelter-in-place

low toxicity and long duration

evacuate

high toxicity and long duration

calculate indoor concentrations (done by HAZMAT); evacuate if necessary

nurse's role in radiologic disaster

Identify type of radiation

Assess radiation absorption

Identify route of exposure

Evaluate exposure time frame

In the event of radiologic disaster

people should leave the area quickly (distance, time); enter the nearest building (shielding); cover their noses and mouths; remove their clothes and seal them in double-thickness trash bags; shower as soon as possible (decontamination); clean and cover any open wounds; and listen to the radio, watch the television, or access the state's website.

nurse's role in blast injuries

Triage

Assess morbidity and mortaliy

communication/deafness

Assess blunt injuries

Prevent infection

the improvisational use of tourniquets on bombing victims on-site has been documented to be...

effective intervention to stop bleeding and ultimately save lives

category A biological agents

Highest priority, posing a risk to national security because they are easily transmitted and have high mortality rates

examples of category A

smallpox, botulism, anthrax, tularemia, viral hemorrhagic fevers (Ebola), and plague

category B biological agents

Second-highest priority, moderately easy to disseminate and have high morbidity rates and low mortality rates

category B examples

typhus fever, ricin toxin, diarrheagenic E.coli, and west nile virus

category C biological agents

Third-highest priority, compromising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates

category C example

hantavirus, influenza virus, tuberculosis, and rabies virus

manifestation of inhalation anthrax

Headache

Fever and chills

Muscle aches

Chest discomfort

Severe dyspnea

Shock

manifestations of botulism

Double or blurred vision

Slurred speech

Difficulty swallowing

Progressive muscle weakness

Difficulty breathing

manifestations of small pox

High fever, fatigue, head/body aches

Rash: begins on face/tongue; spreads to trunk, arms, and legs; then hands and feet; turns to pus-filled lesion

Onset: sudden fever with severe aches and possible vomiting

Rash appears 2-4 days after fever

Lesions: same state of development, deep vesicles, and do not collapse when punctured

ebola manifestations

Fever

Severe headaches

Joint and muscle aches

Fatigue and weakness

Hemorrhage

Vomiting and diarrhea

Shock

pneumonic plague

fever, headache, weakness, pneumonia with SOB, chest pain, cough, bloody or watery sputum

bubonic plague

swollen, tender lymph nodes, fever, headache, chills, weakness

septicemic plague

fever, chills, weakness, prostration, abdominal pain, shock, DIC, gangrene of nose and digits

tularemia manifestations

Sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, progressive weakness

If airborne, life threatening pneumonia and systemic infection