WEEK 11 COMMUNITY NURSE

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Chapter 20: Community Preparedness: Disaster and Terrorism

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

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.

Question #1

Is the following statement true or false?

Disasters are considered events that require a swift, intense response on the part of existing community resources.

Answer to Question #1

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.

Emergencies

Emergencies are considered events that require a swift, intense response on the part of existing community resources.

Disasters

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 to which the event affects the community

Three Types of Disasters

Natural

Accidental

Terrorism

Disaster Management

Preimpact

Impact

Postimpact

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

National Response Framework

Point‐of‐Distribution Plans

Point of distribution (POD)

Emergency Dispensing Site (EDS)

Question #2

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.

Answer to Question #2

False

Rationale: All response begins at the local level, where the disaster management plan is implemented and responders are deployed.

MRC and CERT Groups

Mitigation

PPE

Response

Incident command system

Field triage

Mental health issues

Recovery

Roles of Nurses in Disaster Management

Public health nurses as first responders

Assess community needs as events unfold

Conduct surveillance for communicable disease

Prevent and control spread of disease

Maintain communication channels

Organize and manage PODs

Provide on‐site triage as needed

Manage behavioral responses to stress

Ensure health and safety of self, colleagues, and public

Document events and interventions

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

Detection

Bioterrorism Agents

Anthrax

Botulism

Plague

Smallpox

Tularemia

Viral hemorrhagic fevers

Ebola precautions

Chemical Disasters

Unlike biologic 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.

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

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.

Question #3

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.

Answer to Question #3

False

Rationale: Evacuation occurs when there is potential for massive explosions and fire as well as for long‐duration events. Invacuation occurs when people in a hospital or residential facility are moved to another floor or area within the facility.

Evacuation

Evacuation occurs when there is potential for massive explosions and fire as well as for long‐duration events.

Invacuation occurs when people in a hospital or residential facility are moved to another floor or area within the facility.

Radiologic 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

Blast Injuries

Explosions in confined spaces are associated with higher morbidity and mortality.

Communication with victims may be difficult due to sudden temporary deafness.

Many injuries are not life‐threatening due to blunt force trauma from flying debris.

Open wounds have increased chance to become infected.

Triage and lifesaving efforts should not be delayed because of the possibility of a dirty bomb detonation.

Detailed assessments and on‐site evaluations are counterproductive to decreasing mortality

Public Health Disaster Response

Scope and magnitude of response

Communication during a disaster

Recovery and after‐action evaluation