The most important aspect in managing a disaster situation is preparedness. The simulation Disaster in Franklin County highlights the role of public health personnel, with emphasis on the public health nurse because the nurse is often a first responder to such a disaster. This helps to examine the roles, actions, coping methods, and techniques used by a nurse in a disaster scenario. A. Role of Public Health Personnel
The role of public health personnel is to maintain the physical and emotional safety of individuals throughout the community affected by the storm. Those in the Public Health Department are responsible for ensuring the citizens of Franklin County have all the basic necessities for survival, such as clean water, food, shelter, and necessary medications. Because of the varying needs of the community, the Public Health Department is also responsible for maintaining and disseminating up-to-date information on how to obtain help, how to acquire the basic necessities, and health hazards/concerns. The public health nurse assures these needs and concerns are met within her scope of nursing practice, using her assessment and prioritization skills.
While the public health nurse is assessing the needs of those affected, other members of the Public Health Department maintain operations and assume any jobs that fall outside of the nursing scope of practice utilizing each individual’s skills: the health educator is able to draft concise and easily understood directions relating to maintaining health and directing those displaced to the nearest shelter; the department bookkeeper maintains the financial records during the disaster operations; the receptionist uses her connections with vendors and general people skills to obtain what is needed to run the department; the epidemiologist’s analytical approach and organized thinking is essential in mapping out the logistics of emergency departmental operations; and the environmental health supervisor, who has the most supervisory experience, oversees all operations by the Public Health Department, attends important briefings, and delegates tasks. B. Chain of Command
Establishment of a chain of command in a situation such as a severe storm or other disaster is essential. Because there may be a disruption to commonly used manners of communication, such as television, telephones, and the internet, it is important to have a clear outline of where and to whom to report, how to find answers, and who will perform necessary tasks. In the simulation, the Public Health Department is both a link in the larger, county-wide chain of command and has its own hierarchy structure. Within the scope of the county, the Public Health Department reports to the Medical/Health Branch Director who is directly under the Operations Chief. The Operations Chief, who is in charge of managing and monitoring the actions of each department, reports to the Emergency Operations Commander.
The Emergency Operations commander is the highest link in the chain, not only overseeing the operations of the various governmental departments, but also the officers in charge of Safety, Public Information, and Legal. Within the Public Health Department, like in the county structure, there is an Operations Chief, responsible for all the actions taken by the department. This is someone with experience in the field, supervisory experience, and an understanding of the structure and function of the department. Under the Operations Chief, there are officers for Logistics, Planning, Finance/Administration, Public Information and Liaison. Each of these individuals is chosen according to his or her individual strengths and abilities within the department and is accountable for the actions of the Public Health Department.
Through the county-wide set up of an Incident Command System (ICS), the public health nurse has many resources available to her to aid the community. To spread information about boiling water for safe use, the nurse has the assistance of the Public Information officers of both the Public Health Department and the county. Also, because of a pact Franklin County has made with neighboring REPLACE County, the Public Health Department is able to promptly begin inspections needed to reopen restaurants, providing needed food and a sense of normalcy to the people. While conducting door-to-door interviews, the nurse has additional members of the ICS present to assist in assessing the safety of homes and to aid in the evacuation of residents in unsafe or dangerous environments. After the providing immediate needs, the nurse is able to aid those affected by the storm emotionally and/or psychologically by referring them to hotlines and other practioners
in the area for assessment and treatment. D. Actions of Community Health Nurse
The community health nurse is, through door-to-door interviews with residents most affected by flooding and power outages, able to intervene in unsafe situations. The nurse prepares before the interviews, benchmarks for the determination for safety. The nurse assesses these benchmarks by enquiring if residents have adequate food and medications, know how to safely consume water, have any injured, young or elderly who need assistance, have safe shelter and know of the resources available to them. When confronted with emergency situations, the nurse uses her connections in the ICS to aid citizens.
After discovering a potentially hazardous chemical spill, she cautions the resident against the cleaning the spill himself and deploys an Environmental Health Specialist to assist. The nurse also intervenes to stop a situation from becoming hazardous by instructing another resident that the operation of a generator indoors requires adequate ventilation, thereby preventing a carbon dioxide poisoning. Finally, the nurse assists a resident without an adequate supply of life-sustaining medication in obtaining a resupply and further offers him help in evacuating to a shelter if preferred. In addition, the nurse is able to make referrals to other social service departments for those who will need further assistance even after basic needs are met. E. Coping with Aftermath
An important part of aiding a community after such a disaster is understanding the long term effects on everyday life. The public health nurse is instrumental in assisting those affected emotionally and financially with the appropriate resources. In the scenario, the nurse is able to aid those calling the Public Health Department by recognizing the issues caused by the storm and taking steps to get help where needed.
The nurse refers a woman whose family is having difficulty dealing with unemployment and anger after the storm by suggesting counseling and scheduling a home visit to further assess needs. Another way the nurse aids the community is by recognizing potential serious hazards and dispatching the appropriate members of the Public Health Department to aid in assessment and stabilization of the environment. Finally, the nurse acts swiftly in a confirmed hazardous situation by notifying Emergency Medical Services of an injury in an area with a large community presence, thereby protecting other citizens from harm and allowing the appropriate actions to be taken to neutralize the danger. E1. Techniques
While interacting with the community during the post-storm phone calls, the nurse used multiple methods to calm the fears of those involved. In the first instance, the nurse was able to support the caller by using language that reflected her own concerns back to her. This allowed the caller to have her fears validated. Also, the nurse provided the caller with reassurance that her family was not alone in dealing with the consequences of the storm and resources through which she might find help. Both of these techniques were useful throughout the calls the public health nurse received as well as maintaining a professional demeanor and using her connections to other departments in the ICS to provide prompt assistance where needed. F. Preparation of Nurses
Emergency situations or disasters on any scale can benefit greatly from well prepared and qualified nurses from a variety of fields. In preparations for large scale disasters, nurses must make sure to maintain current knowledge of emergency services and procedures. This can be accomplished through continuing education with community health focus. Nurses can also participate in city, county, and state wide disaster drills, learning vital skills in a safe but accurate simulation. Nurses can also make sure to understand the policies and procedures of their practice settings regarding disaster situations. Conclusion
As nursing practice expands further into the community, it becomes vital to understand the roles required in a disaster situation. By examining the actions taken, methods used and interactions with other departments, the importance of the community health nurse in maintaining the safety of the public is clear. Public health nurses have the unique position to truly advocate and aid many people in emergency situations.