Chapter 23 Public Health Nursing and the Disaster Management Cycle

1Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 23

Public Health Nursing and the Disaster Management Cycle


Objectives

1. Discuss types of disasters, including natural and man-made.

2. Assess how disasters affect people and their communities.

3. Differentiate disaster management cycle phases to include prevention, preparedness, response, and recovery.

4. Examine the nurse’s role in the disaster management cycle.


Objectives, Cont’d

5. List sources of competencies for public health nursing practice in disaster.

6. Explain how the community and its partners work together to prevent, prepare for, respond to, and recover from disasters.

7. Identify organizations at which nurses can volunteer to work in disasters.


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.


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


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)


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.


The Disaster Management Cycle and Nursing Role

Prevention (Mitigation)Preparedness

ResponseRecovery


Disaster Management Cycle


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.


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.


Preparedness

Personal 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


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)


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


Community Phases of Disaster


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


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


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.


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


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.

Chapter 23 Public Health Nursing and the Disaster Management Cycle

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