Disaster Preparedness in Nursing

Lesson 2: Disaster Preparedness

Objectives

  1. Differentiate emergency from disaster.
  2. Review the 4 phases of disaster management and be able to place nursing actions in the correct phase.
  3. Identify vulnerable populations during an emergency.
  4. Describe health and safety hazards associated with disasters and emergencies.
  5. Prioritize patients during mass casualty triage.
  6. Identify the correct order of operations in case of a fire, including when and how to use a fire extinguisher.
  7. Prepare for exam questions related to Lesson 2.

Introduction

Definitions of Disaster

  • Red Cross Definition: A disaster is “a sudden calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources.”
  • World Health Organization (WHO) Definition: A disaster is an upheaval resulting in the inability of a society or community to functionally manage that upheaval resulting in extensive loss.
  • Federal Emergency Management Agency (FEMA) Definition: Disasters exist on a continuum from an emergency to a major disaster.

Concepts of Emergency Management

  • Emergency Management: The managerial function charged with creating the framework within which communities reduce vulnerability to threats/hazards and cope with disasters.
    • Usually managed by state governments or tribal governments.
  • Disaster Preparedness: Typically managed by the federal government.
    • President's Role: The President must declare it a disaster for FEMA to become involved. Local agencies lead disaster relief efforts, which will be funded by the federal government.

Impacts of Disasters

Consequences Beyond Loss of Life

  • Health Care Infrastructure: Disruption of services for hospital care can lead to devastating losses.
  • Environmental Hazards: Communicable diseases like cholera may increase due to environmental imbalances, such as mold post-flooding.
  • Psychological Impact: Short and long-term psychological, emotional, and social wellbeing effects are significant.
  • Food Shortages: Destruction of crops and disrupted supply lines can lead to shortages.
  • Population Movement: Large influxes of displaced individuals can overwhelm unprepared communities.

Mass Casualty Incident

  • Defined as: “an event that overwhelms the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a short time.”

Types of Emergencies/Disasters

  1. Natural Disasters:
    • Hurricanes, tornadoes, earthquakes, floods, tsunamis, volcanic eruptions, droughts.
  2. Infectious Disease Pandemics: Serious outbreaks affecting large populations.
  3. Man-made Disasters:
    • Accidents (gas leaks, explosions) and deliberate acts (terrorism, shootings, cyber attacks).

Four Phases of Disaster Management

  1. Mitigation: Risk reduction strategies.
    • Examples: Improving infrastructure, coordinated public warning systems.
  2. Preparedness: Planning and training for potential disasters.
    • Examples: Emergency Management Plans (EMP), simulations.
  3. Response: Activities addressing short-term direct effects.
    • Examples: Evacuations, emergency services, hydration.
  4. Recovery: Return to a “new” normalcy post-disaster.
    • Examples: Stabilizing critical infrastructure, restoring services, housing solutions.

Nursing Role During Each Phase of Disaster Management

Mitigation

  • Community Education: Nurses educate on family disaster plans, emergency kits, local hazards.
  • Advocacy: Promote policy changes for community resilience.
  • Vulnerability Assessment: Identify at-risk populations (e.g., older adults, children).

Preparedness

  • Emergency Management Plans (EMP): Involvement in the development and testing through drills.
  • Resource Management: Ensuring availability of medical supplies and personnel.

Response

  • Leadership and Incident Command: Engage in incident command depending on EMP.
  • Triage: Responsibility for client prioritization based on injuries during mass casualty incidents.
  • Direct Client Care: Provide first aid and emotional support.
  • Shelter Management: Care for displaced individuals.

Recovery

  • Long-term Care: Support ongoing care for patients with disaster-related injuries.
  • Mental Health Support: Provide emotional and psychological support to victims and responders.
  • Community Rebuilding: Assist in restoring healthcare infrastructure and community services.

Response Protocols in Disaster Scenarios

Evacuations

  • R.A.C.E. (for fire emergencies):
    • R = Rescue patients.
    • A = Alarm (activate alarm systems).
    • C = Contain the fire.
    • E = Extinguish or evacuate.

Fire Extinguisher Use (P.A.S.S.):

  • P = Pull the pin.
  • A = Aim the nozzle at the fire's base.
  • S = Squeeze the handle.
  • S = Sweep the spray from side to side.

Triage Systems for Mass Casualties

START vs. SALT Triage

  • START Triage:
    • Primary use for adults, based on respiratory rate, perfusion, and mental status.
    • Categories: Immediate (red), delayed (yellow), minor (green), deceased (black).
  • SALT Triage:
    • Developed more recently by the CDC for all age groups.
    • Process includes sorting, assessing lifethreatening conditions, and prioritizing treatment/transport.

Emergency Severity Index (ESI)

  • A system for emergency department triage involving 5 levels based on severity.

Vulnerable Populations

Identifying Vulnerable Groups

  • Common Vulnerabilities:
    • Elderly, individuals with disabilities, low-income families, and children.
  • Considerations for disaster preparedness: Engage with populations that speak different languages, are from diverse cultures, or have disabilities.

Health Hazards Associated with Floods

  • Floodwaters can harbor:
    • Sharp objects, live wires, animal/insect bites, sewage, and harmful bacteria.

Historical Context and Case Studies

Hurricane Katrina (2005)

  • Study of what went wrong after Katrina highlights the importance of preparation and identifying vulnerable populations.

Federal Responses to Disasters

  • Comparison of Responses: Different federal responses analyzed between recent hurricanes (e.g., Maria, Harvey, Irma).

Conclusion

Nursing Interventions

  • Active role in all phases of disaster management can significantly improve community resilience and recovery outcomes.
  • Ongoing evaluation and improvement of service delivery are critical for effective disaster response.

References

  • Additional learning resources provided through links in the lesson, including FEMA resources and psychological support resources for disaster victims.