Disasters, both man-made and natural, occur on a regular basis. It is the responsibility of community officials to prepare ahead of time for these disasters, to ensure residents receive needed care immediately following the disaster and in the following weeks while the community recovers. Because of this communities have created emergency response plans and have trained personnel already in place when such events occur. The following is a discussion of the employees involved in a disaster plan and was obtained from “Disaster in Franklin County, A Public Health Simulation” that was created by the University of Minnesota.
Role of Public Health Personnel
Emergency Operations Center (EOC) Commander is in charge of the disaster recovery, they are responsible for assessing the disaster situation, conducts the initial briefing, coordinates staffing, and if needed recommends a “state of emergency” for the affected area. The Safety Officer monitors and assesses unsafe or hazardous situations ensuring residents and disaster responders remain safe during the aftermath of the disaster. The Liaison Officer is the contact person for supporting agencies that assist with disaster relief; they answer questions and provide briefings as needed to ensure correct information is given to these outside agencies.
The Public Information Officer is responsible for providing the public with health information relating to the disaster, they are also responsible for ensuring the public health staff is informed. The EOC Coordinator is responsible for planning for disasters before they happen. They plan out and test the response procedures to ensure critical business functions can return to normal quickly, any businesses can be repaired in a timely manner, and amount of loss minimized. The EOC is also an integral part of the actual disaster recovery effort after an actual disaster happens.
The Operations Chief is responsible for assessing the situation/emergency, conducts briefing meetings, approves the action plan and authorize its implementation, approves needed resources to complete relief efforts, and works with the Liaison Officer in overseeing the aid process. The Logistics Chief is the coordinator for the emergency operations center, everything from transportation, housing, equipment, supplies, and anything else that is needed. This individual acts as a direct link between relief organizations and the EOC.
The Financial and Administration Chief is responsible for money that is spent during the emergency, approves spending and purchases, takes care of compensation claims, tracks workers hours, and coordinates the process for disaster financial assistance. The Planning Intelligence Chief is responsible for gathering and analyzing information needed by the EOC, such as what area resources are available and where they are located, so the first responders are able to effectively complete their work.
The Public Health Nurse is responsible for working in emergency shelters, triaging patients to ensure those needing emergency care receive the required care, complete door to door interviews of affected communities to ensure residents have what they need to remain safe and healthy, and providing a link between the residents in need and the service providers to meet their needs. (Olson, Larson, Scheller & Freiburg)
Chain of Command
During the aftermath of a disaster the public health nurse reports directly to the Medical/Health Branch Director. This director reports to the Operations Chief, and finally the EOC Commander.
Environmental Health Specialist is utilized to aid residents in the proper way to clean household hazardous waste that can occur after a disaster. Social services can assist families relocate to shelters in the immediate aftermath of a disaster. The added stress of dealing with disasters can increase the possibility of domestic violence; social services can assist these families with counseling, domestic violence shelters for women and children just to name a few. Translators may be utilized to help assess non English speaking families. It is a good idea to have translators available for each of the ethnic groups that live within the community. Information sheets should also be available in multiple languages.
Actions of Community Health Nurse
After a disaster it is important for public health nurses to assist the teams that go door to door to assess the residents in the communities hit by the disaster. Some situations these nurses need to deal with is knowing what other departments are available to help people out when something falls outside the nurses scope of practice. Such as when flooding occurs and there is a hazardous household waste that needs to be cleaned up, the nurse knows what agency needs to come to the house and assess the damage, including what is the best way to clean up the waste.
Other situations include ensuring residents have the supplies needed to survive in the coming days after the disaster. These items would include food both for adults and infants, heat, medicines to name a few. If the nurse is concerned about the amount of supplies the family has she can suggest the family stay at one of the shelters available. Another situation the nurse should be aware of and look for is possible domestic violence. In the moments and days immediately after a disaster the stress level for individuals increases dramatically, this increased stress can lead to violence.
Nurses need to be aware of, and watch for signs of, potential domestic violence. Another situation nurses may need to deal with is when people run out of necessary medicine, oxygen, or need dialysis to name a few. The nurse needs to assess these patients individually and make recommendations as to the best options for their care. These could be anything from recommending the individual stay at home and have needed medicine delivered either later that day or the next to having the person go to a shelter for a couple of days. Some individuals may need to be sent to the hospital for treatment.
Coping with Aftermath
For several weeks following a disaster residents in the community will continue to need help in different areas. Some may need referrals to social services for help finding jobs or help buying food and paying rent. Some may need the assistance of mental health agencies for depression or dealing with the trauma of the disaster. Some individuals may need an environmental health specialist to assess their residence to ensure it is safe to return to.
The techniques the nurse used while calming the fears of the residents in the community was mainly to listen. The nurse took the time necessary to talk with each individual person ensuring that their needs were met. She explained the services that had been set up to help care for the residents. The nurse also gave the residents choices; she did not dictate what they should do. The overall goal is to ensure everyone receives the care they need, if the public health nurse appears to be judgmental or bossy they risk alienating the individual they are trying to help.
Preparation of Nurses
In the event of a large disaster more personnel would be needed to respond to the needs of a community. Nurses play an integral part in this disaster relief by working in the field during the aftermath to triaging patients at the hospital. Nurses can ensure they are ready to assist the hospital by attending disaster relief training sessions with their employers. When nurses renew their licenses they are given the option of receiving training on disaster relief, many states will provide continuing education to ensure nurses are trained and aware of the services utilized during an emergency.
One thing nurses need to be aware of is they are licensed to practice nursing in the state they have their license in. If a nurse travels to a different state to assist with the aftermath of a disaster they are opening themselves up to civil or criminal charges. Because of this twenty-four states in the United States have organized an agreement known as the Nurse Licensure Compact (NLC). A nurse that is licensed in a state that is included in this agreement can travel, in times of emergency, to any other state that is included in this compact and assist in a nursing role during the disaster relief.
During declared emergencies or disasters some states have enacted laws allowing nurses to assist in the rescue efforts without fear of retribution. On the national level there is the National Disaster Medical System (NDMS), this organization utilizes medical professionals throughout the United States to work on Disaster Management Assistance Teams (DMATs). These teams are federal responders to disasters and their licenses are recognized in all fifty states. (Stokowski)