1. Introduction to Disasters and Disaster Response Basic Biodefense Curriculum Module 1 2005 Modules were developed as part of a grant from the HRSA BTCDP initiative

2. About this Module This module focuses on general concepts surrounding disaster-related health emergencies: Definitions Disaster characteristics Stages of disaster management Disaster plans Roles and responsibilities

3. Learning Objectives: Provide a meaningful definition of a disaster Describe characteristics common to disasters regardless of cause Describe characteristics of disasters caused by intentional acts, such as terrorism Identify and describe the four stages of disaster management Explain the importance of a disaster plan and describe major components usually included in such a plan.

4. Learning Objectives c ontinued Describe the potential roles of health care workers in the event of a disaster Identify sources of pertinent disaster response information Define what is meant by an “All Hazards” approach Identify elements of a disaster response

5. A Disaster is….. “A sudden calamitous emergency event bringing significant damage, loss, or destruction.” National Incident Management System (NIMS) v8.5, February 2004

6. A Disaster is also…… Part of a Continuum of Immediacy and Scope: “Incident” - any out-of-the-ordinary event that requires a response or action “Emergency” - an incident that warrants an immediate response in order to minimize injury, loss of life or damage to property “Disaster” - an emergency incident that overwhelms ones ability to respond or manage the incident alone and requires outside help or resources “Catastrophe” – a large scale mega-disaster

7. Disaster Characteristics Disrupts Normal Routines Creates Panic and Confusion Reaction to disaster can create further harm Often Destroy Systems Communication (telephone, internet, radio, TV) Utilities (water, electricity, sewer, gas) Community Infrastructure (buildings, bridges, roads) Overloads Services that Remain Intact Rescue and emergency (law enforcement, firemen, hazmat) Healthcare (hospitals, emergency rooms, urgent care sites)

8. Two Types of Disasters Natural Geophysical (earthquake, landslide, volcano) Weather (hurricane, blizzard, flood, drought) Infectious (endemic, epidemic, pandemic) Manmade Accidental (leaks, spills, structural failures) Intentional (car bombs, computer attacks)

9. Disasters Caused by Intentional Acts Commonly referred to as terrorism Categorized by the weapon (or agent) used There are five main categories: Chemical Biological Radioactive Incendiary Explosive Intentional acts are also seen in war

10. The Many Faces of Terrorism Do you know this woman? She used a biological weapon to sway an election in an Oregon town. Answer: Ma Anaad Sheela. Poisoned a salad bar with Salmonella bacteria to keep voters away from the polls

11. Do you know this man? He used explosives to make a political statement in Oklahoma City. Answer: Timothy McVeigh. Bombed a federal building and killed hundreds of adults and children The Many Faces of Terrorism

12. Special Characteristics of Intentional Disasters Specific population or area is targeted Designed to maximize publicity & fear Frequently used to further a political goal Uses news media to spread panic Designed to maximize chaos and fear Methods limited only by imagination, technology, cost May be conducted by a few individuals Can be difficult to predict

13. 1995 Sarin Attack in Tokyo Imagine working at a Tokyo hospital on the day Sarin nerve gas was released in the subway system Sarin is most toxic when inhaled, but may also be absorbed through the skin Secondary contamination occurs when skin or clothing of a victim is touched

14. Begin Video Clip Some things to watch for: How patients get to the emergency room What happens as cars are abandoned outside How healthcare workers are exposed to secondary contamination How patients are cared for inside the hospital

15. Disaster Timeline

16. Disaster Response Should Begin… 1. Prevent

17. FEMA Disaster Management Stages FEMA’s Four Stages: 1.Prevent 2.Prepare 3.Respond 4.Recover For each stage, identify: Key Individuals Functions Resources Organizations (Federal Emergency Management Association (FEMA): http://www.fema.gov )http://www.fema.gov

18. First Stage of Disaster Management 1.Prevention Eliminate or reduce the chance a disaster will occur before it happens

19. Prevention Stage Activities Remain alert to dangers Early detection and reporting To promote early containment To reduce overall casualties Provide accurate information Educate others about disaster response Vaccinate and provide prophylaxis What else can you do to prevent a disaster?

20. Second Stage of Disaster Management 2.Preparedness (or preparation) Prepare response plans, train personnel, and locate or increase resources

21. Preparation Stage Activities Participate in the planning process Local Emergency Planning Committee (LEPC) Tribal Emergency Response Commission (TERC) Develop a personal or family disaster plan Review your institution’s disaster plan Find your role in the plan Obtain disaster training maintain existing skills add new ones Practice response skills Participate in drills and simulations What else can you do to prepare?

22. Third Stage of Disaster Management 3.Response Engage in activities during and immediately after a disaster to save lives and minimize secondary damage

23. Response Stage Activities Think both ACUTE and POST-ACUTE Provide acute care for victims and responders Provide support for other caregivers Backfill positions left vacant by practitioners responding to disaster Provide patient education What else can you do in a response?

24. Fourth Stage of Disaster Management 4.Recovery Continue response activities until all systems return to normal

25. Recovery Stage Activities Monitor for stress and psychological effects Including post-traumatic stress syndrome Patients, responders and yourself Monitor patient progress Anticipate long-term treatment needs Monitor for delayed physical effects Evaluate effectiveness of response What else can you do during recovery?

26. Disaster Response Pearls A good disaster response begins long before a disaster occurs Planning, training, coordination, and practice are essential Networking with responders from other agencies before a disaster will facilitate communication

27. Planning is Key Process “I have always found that plans are useless, but planning is indispensable.” Dwight D. Eisenhower

28. The “All Hazards” Approach An “All Hazards” disaster plan or response focuses on identifying and addressing the needs created by a disaster, rather than what caused the disaster A flood or tornado disaster plan is not an “all hazards” plan – it is focused on a specific disaster The “all hazards” approach does not eliminate the need to prepare for disasters that will require specific responses

29. Plans Come in Many Sizes Individual or Family Institutions For disasters within institution For participating in community-wide disasters Cities Counties State Federal Global?

30. No Plan Can Anticipate Everything…. ….be Flexible!

31. Information Found in Most Plans Management system (“Command and Control”)

32. Information Found in Most Plans Management system (“Command and Control”) Communication system

33. Information Found in Most Plans Management system (“Command and Control”) Communication system List of resources

34. Information Found in Most Plans Management system (“Command and Control”) Communication system List of resources Damage control mechanisms

35. Information Found in Most Plans Management system (“Command and Control”) Communication system List of resources Damage control mechanisms Transportation coordination Evacuation and rescue procedures

36. Information Found in Most Plans Management system (“Command and Control”) Communication system List of resources Damage control mechanisms Transportation coordination Evacuation and rescue procedures Acute and supportive care protocols

37. Information Found in Most Plans Management system (“Command and Control”) Communication system List of resources Damage control mechanisms Transportation coordination Evacuation and rescue procedures Acute and supportive care protocols Recovery stage procedures Response evaluation plan

38. Normal vs. Disaster Rules Usual practice situations are controlled by laws and rules During a declared emergency, these rules may bend or break Find out how a Declaration of Emergency (Disaster) affects your scope of practice For Example: Normally, a hospital must evaluate and treat an injured person who is on their property. If a disaster plan describes how the hospital will create and use alternative care sites, it is okay to refer injured patients to those other sites. See COBRA/EMTLA rules

39. Sources for Current Information Centers for Disease Control and Prevention (CDC) website: http://www.bt.cdc.govhttp://www.bt.cdc.gov Sites supported by your discipline’s professional organizations Local health departments, alert networks or other listserves: http://www.bt.cdc.gov/clinregistry/http://www.bt.cdc.gov/clinregistry/ American Red Cross: http://www.redcross.org/http://www.redcross.org/

40. Summary Disasters may be natural or man-made An “All Hazards’ approach to disaster response is a comprehensive plan for responding to any type of disaster Recent acts of terrorism have increased interest in training the healthcare workforce to effectively recognize, report and respond to disasters.

41. Summary continued Disaster management begins before an event occurs and continues until the community returns to normal Disaster preparedness includes training and planning Disaster plans are used to guide a disaster response Knowing where to find current information is key

42. Authors Jean Carter Sandra Kuntz Earl Hall Steven Fehrer Steven Glow Jacqueline Elam Michele Sare Lisa Wrobel Michael Minnick Modules prepared as part of the Montana Basic BioDefense Curriculum For Pharmacy, Nursing, and Allied Health Funded by the HRSA CFDA 93.996 initiative

43. Photo Credits Do not reproduce individual photos or videoclips without permission from original source. A list of photo credits was included in the instructor’s packet. To request a copy of the photo credits, send an email to jean.carter@umontana.edu jean.carter@umontana.edu Modules prepared as part of the Montana Basic BioDefense Curriculum For Pharmacy, Nursing, and Allied Health Funded by the HRSA CFDA 93.996 initiative