1. Prevent disease
2. Prevent recurrence
3. Rehabilitation of victims. Community responds with resilience: back on feet as quickly as possible.
Nature of Disasters
Emergency: beyond resources of state. Requires Federal emergency assistance.
Major Disaster: emergency leading US President to release additional funds. FEMA - requires governor to request declaration of disaster area.
ARC: guide for shelter managers
ANA: disaster management paper
Latinos: often least prepared. 65 yo and above least prepared.
With training, drills - more prepared, find gaps in planning/services
Technological: blackout following tsunami, meltdown, etc.
Predictable: hurricane can be predicted, earthquake cannot
Controllable: can control effect of floods, fires - cut brush, build walls
Speed of onset: hurricane - slow; tornado - fast
Length of forewarning: how much notice? earthquake - none; hurricane - many hours
Duration of impact: tornado - short; earthquake, floods - weeks
Scope and intensity of impact: Geography, population density; coastal bowls, e.g., Katrina. Dense population, poverty heightened risk.
Disaster as Global Public Health Problem
Disruption to communication, transportation, utilities
Loss of shelter, food, medicine, medical care
Leads to: increased mortality, nutritional deficits, environmental exposure, infectious Dx, psychological stressors...
Populations at risk
Those with fewest resources
Chronically sick, frail, elderly, PG, disabled, homebound, children
Poverty, social inequality, rapid population growth, environmental degradation, substandard housing, low education, living in undesirable/dangerous tracts of land (flood plains)
Stages of Disaster
1. Non-disaster: plan
2. Predisaster/Warning: Communicate, prepare
3. Impact: "holding on" - occurrence of event
4. Emergency: Assess, isolate, rescue, remedy
5. Reconstruction/Rehab: healing, rebuilding (cleanup can take years)
1. Local agencies respond
2. If overwhelmed - State/National Guard steps in.
3. Local, state, Federal damage assessment
4. When state resources exhausted, governor requests Disaster Declaration
5. FEMA evaluates and makes recommendations to White House
6. Executive order given/denied
1. Local/public health
2. Regional - 2 or 3 counties
Secondary: Parking lot of hospital
Assign color based on criticality of person
Red: immediate care/ STAT
Yellow: can wait a bit
Green: can wait til later
Role of CHN in disasters
Good phys assessment skills
Knowledge of teamwork, collaboration
Skilled in program planning, community assessment, group dynamics
CHN role: nursing approaches
1. personal preparedness
2. Community involvement
3. Professional preparedness
Space, supplies, equipment, scheduling, reports, records, 1st aid, triage, Dx prevention, emotional support, communication, coordination, anticipation
Application of nursing process
Assessment, Planning, Implementation, Evaluation
Incident Command System: from US military, specific to each location/service, standard on-scene hazard incident response, flexible command structure
National Incident Management System. Comprehensive national response approach; all levels, across functional discipline.
Prevents duplication & waste
Top problem during disaster
Inter-agency planning meetings monthly