1. Chapter 23 Public Health Nursing and the Disaster Management Cycle

2. Objectives Discuss types of disasters, including natural and man-made.
Assess how disasters affect people and their communities.
Differentiate disaster management cycle phases to include prevention, preparedness, response, and recovery.
Examine the nurse’s role in the disaster management cycle.

3. Objectives, Cont’d
List sources of competencies for public health nursing practice in disaster.
Explain how the community and its partners work together to prevent, prepare for, respond to, and recover from disasters.
Identify organizations at which nurses can volunteer to work in disasters.

4. Defining Disasters
Any natural or man-made incident that causes disruption, destruction, and/or devastation requiring external assistance
The disaster event type and timing predict subsequent injuries and illnesses.
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.

5. Disaster Facts
Can affect one family at a time or can affect millions of people
American Red Cross responds to a disaster in the United States every 8 minutes (over 70,000 incidents each year)
Number of reported natural and man-made disasters continues to rise worldwide
Number of lives lost decreased but number of people affected increased
Disaster disproportionately strikes at-risk individuals
Monetary cost of disaster recovery effort have risen
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.

6. Homeland Security: A Health-Focused Overview
Homeland Security Act of 2002
Homeland Security Presidential Directive (HSPD-8)
National Preparedness Guidelines (NPG)
National Response Framework (NRF)
Homeland Security Presidential Directive 5 (HSPD-5)
National Incident Management System (NIMS)
HSPD-21: Public Health and Medical Preparedness and the National Health Security Strategy (NHSS)
Pandemic and All-Hazards Preparedness Act (PAHPA)

7. Healthy People 2020
Disaster incidents have an effect on almost every objective.
Disasters play a direct role in the objectives related to environmental health, food safety, immunization and infectious disease, and mental health and mental disorders.

8. The Disaster Management Cycle and Nursing Role
Prevention (Mitigation)
Preparedness
Response
Recovery
Disaster management includes four stages: prevention (or mitigation), preparedness, response, and recovery.
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.

9. Disaster Management Cycle

10. WADEM Nursing Section
World Association for Disaster and Emergency Medicine (WADEM) includes a nursing section
Purpose of this section is to:
Define nursing issues for public health care and disaster health care.
Exchange scientific and professional information relevant to the practice of disaster nursing.
Encourage collaborative efforts enhancing and expanding the field of nursing disaster research.
Encourage collaboration with other nursing organizations.
Inform and advise WADEM of matters related to disaster nursing.

11. 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 against natural disasters:
Structural and non-structural measures
Prevention against man-made disasters:
Include heightened inspections; improved surveillance and security operations; public health and agricultural surveillance and testing; immunizations; isolation; or quarantine and halting of chemical, biological, radiological, nuclear, and explosive (CBRNE) threats.
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.

12. Preparedness Personal preparedness Professional preparedness
Disaster kits for home, workplace, and car
Professional preparedness
National Disaster Medical System (NDMS)
Disaster Medical Assistance Team (DMAT)
Medical Reserve Corps (MRC)
Community Emergency Response Team (CERT)
Community preparedness
National Health Security Strategy (NHSS)
Disaster and mass casualty exercises

13. Response
First level of disaster response occurs at the local level with the mobilization of responders, such as the fire department, law enforcement, public health, and emergency services
National Response Framework (NRF)
Emergency Support Functions (ESF)
National Incident Management System
Response to bioterrorism
BioWatch, BioSense, Project BioShield, Cities Readiness Initiative, Strategic National Stockpile (SNS)

14. How Disasters Affect Communities
Stress reactions in individuals
Table 23-3 (p. 522) lists symptoms that may require assistance
Exacerbation of a chronic disease
Older adult’s reactions dependent on health, strength, mobility, independence, and income
Regressive behaviors
Stress reactions in the community
Heroic
Honeymoon
Disillusionment
Reconstruction

15. 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.
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.

16. Role of the Public Health Nursing (PHN) in Disaster Response
First responder
Triage and public health triage
Epidemiology and ongoing surveillance
Rapid needs assessment
Disaster communication
Sheltering
Special needs shelters

17. Psychological Stress of Disaster Workers
Vicarious traumatization
Degree of workers’ stress depends on the nature of the disaster, their role in the disaster, individual stamina, and other environmental factors
Symptoms that may signal need for stress management assistance
Environmental factors include noise, inadequate workspace, physical danger, and stimulus overload, especially exposure to death and trauma.
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.

18. Recovery
Recovery is about returning to the new normal, a community balance of infrastructure and social welfare that is near the level that it would have had if the event had not occurred.
The recovery phase is often the hardest part of a disaster.
For large scale events, federal government provides assistance with rebuilding and restoring.
Shift from short-term aid to long-term support for communities: sustainment of effort.

19. Role of PHN in Disaster Recovery
Psychosocial support
Acute and chronic illnesses become worse by the prolonged effects of disaster.
Feeling of severe hopelessness, depression, and grief in the disillusionment phase
Recovery can be impeded by short-term psychological effects that eventually merge with the long-term results of living in adverse circumstances.
Majority of individuals will eventually recover from disasters but mental distress may persist for months to come

20. Future of Disaster Management
Nurses must continue to plan and train in an all-hazards environment, regardless of their specialty practice.
PHNs are especially critical members of the multidisciplinary disaster health team, given their population-based focus and specialty knowledge in epidemiology and community assessment.
Staying current in disaster training requires the PHN’s commitment in community planning activities, exercise participation, and actual disaster work.