1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 19: Community Preparedness: Disaster and Terrorism

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter Highlights History of public health nurses and disaster response Types of disasters Disaster management Public health response Role and responsibility of nurses in disasters Classification of agents Field response Skill building for field activity

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Roles Nurses play an important role in all phases of disaster response. All practicing nurses should become familiar with disaster phases and their role during an event. Public health nurses practice principles of disaster response on a daily basis.

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Disasters are considered events that require a swift, intense response on the part of existing community resources.

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Emergencies are considered events that require a swift, intense response on the part of existing community resources. Disasters are often unforeseen, serious, and unique events that disrupt essential community services and cause human morbidity and mortality that cannot be alleviated unless assistance is received from others outside the community.

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Emergencies Emergencies are considered events that require a swift, intense response on the part of existing community resources.

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Disasters Disasters are often unforeseen, serious, and unique events that disrupt essential community services and cause human morbidity and mortality that cannot be alleviated unless assistance is received from others outside the community. Disasters vary by the following points: – The type of onset –The duration of the immediate crisis – The magnitude or scope of the incident –The extent that the event affects the community

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Three Types of Disasters Natural Accidental Terrorist attacks

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Disaster Management Preimpact Impact Postimpact

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparedness Although disasters do not occur with frequency, planning with vulnerability assessment can reduce the impact on the community. Identification of hazards Analysis of vulnerability Assessment of risk

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Identification of Hazards The identification of all existing and potentially dangerous situations before disasters occur is the first step in planning for an effective response. The types and combination of hazards are unique to a community.

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Analysis of Vulnerability Vulnerability analysis predicts who will be affected the most and identifies community resources that are available for a response.

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Risk Using the comprehensive data gathered from hazard identification and vulnerability analysis, the probability of adverse health effects due to a specific disaster can be calculated. This is often represented as a low, medium, or high risk.

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins National Response Framework Framework that guides how the nation conducts all- hazards incident response

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Mitigation Mitigation is an effort to prevent identified risks from causing a disaster. Mitigation involves 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.

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? All response begins at the state level, where the disaster management plan is implemented and responders are deployed.

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: All response begins at the local level, where the disaster management plan is implemented and responders are deployed.

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Response Incident command system –Common organizational structure implemented to improve emergency response National Incident Management System –Structured, flexible framework that guides the response to disasters at all levels of governments, private companies, and nongovernmental organizations

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Recovery Recovery is the stabilization of the community and the return of the disaster area to its previous status.

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Adverse Health Effects After Any Kind of Disaster Continuing death, chronic illness, and/or disability Population shift if recovery is prolonged Contamination of food and water supplies, with an increased risk of infectious diseases Collapse of local and regional health care access Increased need to provide mental health services— “psychological first aid” for disaster victims and responders

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Foundation for evidence-based disaster response Following a thorough review of the responses, a final report is prepared with recommendations for improving emergency response in the future.

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Roles of Nurses in Disaster Management Public health nurses as first responders Just in time training Field triage Point of distribution plans Personal protective equipment Documentation in a disaster Skill building for disaster response

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Bioterrorism History Categories of bioterrorism agents –Can be easily disseminated or transmitted from person to person –Result in high mortality rates –Have the potential for major public health impact –Might cause public panic and social disruption, and require special action for public health preparedness

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Detection of a Bioterrorism Event Anthrax Botulism Plague Smallpox Tularemia Viral hemorrhagic fevers

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chemical Disasters Unlike biological agents, which require an incubation period before symptoms appear, a chemical agent, when released, makes its presence known immediately through observation (explosion), self-admission (accidental), or the occurrence of rapidly emerging symptoms, such as burns, difficulty breathing, or convulsions.

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of Nurses in a Chemical Disaster Stay or go, the evaluating factors include the following: –The hazardous material involved –The population threatened –The time span involved –The current and predicted weather conditions –The ability to communicate emergency information

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Shelter-in-Place Shelter-in-place is used for short duration incidents, when moving would result in a greater hazard, or it is impractical to evacuate.

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Evacuation, where people in a hospital or residential facility may be moved to another floor or area within the facility, may occur.

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Evacuation occurs when there is potential for massive explosions and fire as well as for long–duration events. Invacuation, where people in a hospital or residential facility may be moved to another floor or area within the facility, may occur.

30. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evacuation Evacuation occurs when there is potential for massive explosions and fire as well as for long–duration events. Invacuation, where people in a hospital or residential facility may be moved to another floor or area within the facility, may occur.

31. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Radiological Disasters The health outcome depends on the following: –The amount or dose of radiation absorbed –The type of radiation –The route of exposure –The length of time exposed to the dose Dirty bombs

32. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Public Health Disaster Response Scope and magnitude of response Communication during a disaster Recovery and after action evaluation