Nurses play a major role in responding to natural or man-made disasters. They are often on the frontlines of the recovery effort. It is crucial to understand their role and how they collaborate with others on the response team to ensure a positive outcome. There is a definitive chain of command in the wake of a disaster. In our scenario, it is a three-tiered staff. At the highest level is the incident commander. No matter the size of the incident, there is always one leader appointed. This role assumes overall management of the entire incident and is updated by appointed staff in specific areas. Critical roles include ensuring staff’s safety, providing information services, and maintaining a good working relationship with other services (IS-100.HCb). Reports by staff in other disciplines are given to the incident commander frequently throughout the initial every phase in the disaster.
The second tier in the chain of command consists of the public health information officer who acts as a liaison with the news medical and for coordinating all news media activity at the incident, and a liaison officer who is responsible for interacting with other organizations that do not become part of the incident command system structure. At the functional level, the operations chief assumes responsibility of developing and implementing strategies to carry out the incident objectives. The planning chief manages the planning process to compile the incident plan; they are always looking forward to the needs of the team. To ensure that resources and services are obtained to support the achievement of the incident objectives, the logistics chief makes contact outside resources. Finally, the finance/administration chief aids in monitoring costs. The provide accounting, procurement, time recording, and costa analyses to ensure that funding is being utilized efficiently (IS-100.HCb).
All of the disciplines come together throughout the scenario, over several days, to discuss progress at routine briefing meetings. At the meetings their progress is assessed, new needs are addressed, and a plan of action is put into place by delegating work to the appropriate team member. For public health staff, some of their primary focus during a disaster is to communicate health related effects to government agencies, coordinate emergency and routine health care immediately after a disaster, prevent injury, and promote food and water safety, vector control, and control of communicable disease. They may play a role in inspecting shelter sites for health risks. They evaluate the needs of victims in a disaster and assure that follow-up care is provided (Clark, 2008). In the scenario the public health staff and the public health nurse participated in briefings and compiling of public announcements to address major concerns in the community. One example is during the briefing on day one at 4:30 p.m., three messages are put out to the community addressing imminent concerns.
The first message is a boil water notice; the second is to inform the public of the temporary shelter, and finally how to manage with loss of power regarding food safety. The messages should be concise and clear. In the door-to door interviews immediate health needs were assessed and addressed by ensuring that victims had adequate basic supplies, medication, and access to medical equipment. The team responding to the effected community gave residents basic supplies such as water and childcare supplies. Education was given to each resident on the emergency response to the flooding, lack of electricity, and food preparation. Through education and discussion, the public health nurse is able to calm residents and offer them choices to best address their situational needs. Disasters can have an emotional and psychological effect upon residents.
The public health nurse can assess the need for additional resources during their discussions and by asking appropriate questions to gain knowledge regarding the strain on each resident. Additional resources are directed to each residence depending upon the initial assessment. Such resources may include environmental health specialists, social workers, dieticians, and psychiatrists. When completing the inspection of the shelter, the community health nurse participated in inspecting basic hygienic needs such as the bathrooms and hand washing facilities. While the public health nurse completes necessary duties, they rely heavily on the other members in the chain of command. The public health nurse collaborated with the environmental health specialist to complete the inspection of the shelter. When the need for hand washing stations and port-a-potties was noted they addressed this at the report back to the emergency operations center (EOC) commander.
After reporting back, the third tier of the public health command system was able to obtain the necessary items. Also while completing the shelter inspection, then public health nurse and environmental health specialist noted that the need for animal control. Some families brought in their pets to the shelter. After noting the sanitary concerns the families were asked to stay in an isolated area of the shelter with their pets. They were also given the option to lodge at a church run shelter as their policy regarding pets may be more lenient. Contact was made to the local humane shelter and surrounding families to aid in housing the pets while the families were displaced. The public health team relies on the planning and operations chief to aid in making these arrangements. One of the most important tasks that the public health nurse is given is the door-to-door interviews.
This occurs during the emergency stage of the disaster response. There are two sub-stages in the emergency stage. Initially first aid is given, rescue efforts are made, and emergency treatment is provided. As time goes by, other disciplines are brought in to assist in relief and public health issues caused by the disaster (Clark, 2008). It is crucial that the public health nurse address possible emergency situations to ensure the overall safety of the community. During the interviews, house number one states that the basement had been flooded and chemicals had spilled in a shed. The public health nurse assesses that and environmental health specialist is needed to assist with clean up, assess for mold, and advise on disposal of household waste. Arrangements are made for the environmental specialist to come to the home.
The family was not in immediate harm and chooses to remain at the residence. The public health nurse proceeds to the second home where, through a series of questions, notes that there are small children in the home in need of basic supplies. The mother of the family is left to also care for her mother-in-law and the spouse is angry and not present to offer support. After discussion, the mother decides to remain in the home but is quite stressed with all of her responsibilities. Basic supplies are provided, the option to come to the shelter is discussed, and there is no evidence of imminent spousal violence. The public health nurse will schedule a one to two week follow-up with the family and has given a telephone contact to the mother for further assistance if any other problems should arise. Follow up with the family in a few days to establish if there is a need for more supplies.
The next home is Spanish-speaking. A son of the homeowner is able to speak English and communicate with the public health nurse. The home appears safe after a tour is completed and a generator is running in an outback shed with improper ventilation. The home seems to be adequate for inhabitance. The nurse instructs the son on how to properly operate a generator. A staff member will return to further evaluate with the assistance of a translator and will bring educational materials written in Spanish to address food and water safety and proper use of generators. While interviewing the fourth and final home on the block, the nurse notes that a man is in need of medications for hypertension. Due to the flooding he is offered to come to the shelter where his medical condition may be monitored more closely and pharmaceuticals and can be delivered in a timely manner.
He does have access to safe food and water and blood pressure check is performed. After a discussion of the situation, the man is asked whether he’d like to stay in the home and it is decided that a stay at the shelter would be safer in his situation. The public health nurse was able to ensure the safety of residents in this community by utilizing a specific list of questions that addressed possible problems. Some of the questions involved asking about children in the home, safe food and water supplies, need for medications or medical supplies, flooding of the home, and the option to stay at the shelter (Regents of…, 2006). It is important to provide adequate information and involve homeowners in the discussion of evacuation. The goal is to empower the residents to make competent and appropriate choices regarding their specific needs and situation. Imminent safety needs are addressed by the public health nurse.
This is done via discussion or by allocating additional resources to the homes. Identifying and addressing potential hazards ensures that the residents can trust the emergency response team and calms them during the chaos of the emergency. Victims of disaster need support, not only during the disaster but throughout the recovery process. It is important to recognize both internal and external mechanisms for coping. Helping people work through their feelings and finding strength from within through counselling may be a good coping strategy. To reduce distress and achieve a feeling or normalcy, disaster workers can educate the public and individuals on what to expect throughout the process and provide helpful tips via public announcements, handing out pamphlets, or directing the public to a crisis center. Financial strain is an issue for many involved in disasters. It is important to assist victims in contacting their insurance companies, local volunteer groups, and governmental support agencies (Becker, 2008).
By utilizing as many resources as necessary for each individual situation results in a strong community built upon knowledgeable and confident residents. It is crucial that nursing staff be prepared to handle disasters in a professional, safe, and effective manner. The involvement of nursing staff “parallels the stages of the nursing process and involves collaboration in assessment, diagnosis, and disaster response planning, implementation, and evaluation” (Clark, 2008). The emergency response system should be tested via simulation and critical thinking exercises. All nursing staff has the knowledge base of the nursing process and this needs to be applied to scenarios and critical thinking. Community education courses and disaster nursing programs aid in preparing nurses for these situations.
At the employment level, online courses and in-house simulations aid in preparing staff for emergencies. As a nurse within the Veterans Affairs Medical System (VAMC) we are trained using their internet database annually by completing training modules with specific scenarios. Community training, specific to each nurse’s area, exist through American Red Cross chapters, community education opportunities offered at local school districts, and local medical facilities. These types of training will ensure that nurses have the basic framework needed to address disaster situations. Studying the chain of command and how to communicate within it is a skill that can be developed prior to an actual emergency. The simulation “Disaster in Franklin County, A Public Health Simulation” has helped me work through the response steps and how to apply my nursing knowledge to a disaster situation.
Becker, K., Sapirstein, G., Weir, J. (2008). Psychological Support for Survivors of Disaster, A Practical Guide. Corporate Citizenship and Corporate Affairs, IBM. Retrieved from: http://www.stimulusorg.com/files/Psychological%20Support%20for%20Survivors%20
Courtney from Study Moose