Emergency Preparedness

1 January 2017

Risk for disasters is a part of life; emergency situations occur more frequently than many people believe. A wise person plans for the worse, and hopes for the best. After a disaster, how well a community can recover will depend largely on how well they prepared in advance.

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Risk management includes identifying any potential risks to a community and proactively planning to minimize the threat. Proactive organization of resources and people to respond to emergencies can mean the difference between a community’s ability to regroup and recover, and the loss of life. To better understand preparation for emergencies, we will examine and summarize an emergency event and the actions of health care workers in response to specific key characters’ health concerns.

Next, we will identify other types of public health agencies (local, state, and national) that could be called upon to respond to this type of emergency and discuss how public health care teams can enhance personal preparedness for this type of emergency and similar community emergencies. Last, we will offer suggestions to enhance personal preparedness for this type of emergency and similar community emergencies. Summary of Events and People The Neighborhood is a town with a population of 64,200 people, one-third of which are elderly. It is situated along a river and located west of a forest.

For the last five days, a wildfire has been burning out of control in the forest and is nearing the town. This fire, spread by an earlier-than-expected windy season, is destroying numerous acres of land. Firefighters are trying to control this wildfire in the forest, as health care workers are working to help patients with restrictive and obstructive lung disease, experiencing difficulty with breathing. City officials have urged citizens in the Neighborhood not to go outside, unless absolutely necessary.

This advice was given due to the poor air quality from ll the smoke blown by the winds, in the direction toward town. The poor air quality is impacting all of the town’s population; especially those with lung disease. Both the hospital and outpatient clinics are filled to capacity with patients. The city officials have also advised the Neighborhood’s citizens, that currently there is no direct fire danger, but, if the fire gets any closer, and the town is in danger, they will notify the people in advance. Two of the Neighborhood’s inhabitants are Jimmy Bley and his wife, Cecelia, who have been married for 56 years.

Both are Native Americans, in their mid-70s and they both have have health issues. Jimmy suffers hearing loss and moderate emphysema, which he says “it’s not that bad”, yet he frequently is short of breath. Jimmy knows that if he ‘pushes’ himself, he can suffer exhaustion and be ill for days. Jimmy has smoked for most of his life, and has no intention of stopping. Cecelia suffers from osteoarthritis that she says is “an annoyance”. During the poor air quality alert, Cecelia lets Jimmy know that the dryer is broken, yet again. Jimmy knows that he needs to go to the hardware store to purchase the parts and repair the dryer.

Cecelia wants the dryer fixed, but Jimmy knows that he needs to wait until the air quality improves before he goes outdoors. One of the Bley daughters comes over to take Cecelia to the laundromat so she can finish their laundry. The middle school is scheduled, over the weekend, as the site of the annual science fair. More than fifty children from the school are going to this science fair. The event has not been cancelled in spite of the advice to stay indoors due to the poor air quality. The school nurse has assessed one student, in particular, for breathing problems; increased respiratory rate, a cough and wheezing during this week.

The Neighborhood also has a senior center which offers activities, as well as health screenings for the geriatric population. The nurse who runs the center has thirty-plus years of geriatric experience. She has educated seniors to stay inside, away from the smoke irritants in the air, after noting their increased oxygen use and coughing. Actions of Health Care Workers Actions at the Emergency Room and Hospital Neighborhood’s hospital is filled with patients who are ill with exacerbations of asthma and emphysema related to the poor air quality and smoke.

The hospital’s emergency department calls for in-patient beds but there are no beds available. There are more patients needing beds than there are beds available. The emergency room nurses keep calling the floors to request beds, and none are available. The staff morale is low because they all feel the stress related to the pressure of early discharge for patients to make beds available. The nurses are kept busy with discharges and admissions, and are feeling overwhelmed and under-staffed. Hospital administration has decided to implement mandatory overtime adding to the stress of the staff. Actions at the Senior Center

Many seniors have been using their oxygen more frequently. One client has told her he is coughing since the fire began. The geriatric nurse, Karen, who works at the center has advised many seniors to stay indoors and away from the irritants in the air. She has provided health screenings and education to the center’s clients for the last five years. Actions at the School The school nurse, Violet provides coverage for the elementary, middle school and high school in the town. She often feels that she is unable to be as effective as she would like related to the extensive needs of so many students.

This week, a teacher sent a student to the office because of her coughing. Violet assessed the student who had an increased respiratory rate, coughing and wheezing. After the assessment, Violet called the student’s mother to request she come and pick up her daughter from school to be seen at the doctor’s office. Violet also provided education for the student’s mother regarding the benefit of keeping a metered dose rescue inhaler at the school. Resources for Local, State and National Response Assistance Keeping the community safe in times of disaster is a collaborative effort between community, state and national agencies.

Stanhope and Lancaster, (2008) discuss local community health’s responsibility in a disaster, In case of an event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This level of knowledge—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters such as urricanes or floods—has required a level of interstate and federal-local planning and cooperation that is unprecedented for these agencies (pg. 61, Para. 5)

The American Red Cross is a nonprofit organization which helps people after a disaster by providing immediate needs such as food, water, clothing and shelter. (What Happens Now, 2008). The Red Cross could have been accessed to help the Neighborhood with the fire danger. American Red Cross, (2010) writes, “The American Red Cross is where people mobilize to help their neighbors-across the street, across the country, and across the world in emergencies” (Pg. 1 Para. 1).

Another local resource to assist during times of crisis, is a local medical reserve corps. In this writer’s area, the Kootenai County Medical Reserve Corps works with the state of Idaho to provide medical and non-medical volunteers to assist the public’s health throughout the year and in times of crisis. The Medical Reserve Corps of North Idaho, (2010, explain how the corps … recruit healthcare professionals (active and retired) throughout all five counties of the District– physicians, nurses, dentists, pharmacists, psychologists, social workers, EMS, veterinarians and medical/health students.

Non-medical members who can serve as administrative, clerical or support staff during a major public health emergency …are also recruited… has volunteers from medical, public health professionals, and epidemiologists that help improve disaster preparedness and response capabilities for their local jurisdiction. ( pg. 5, para 4) These volunteers can assist an over-taxed medical system to help triage patients and support medical or other staff.

A federal resource for areas struck by fire disaster is the United States Fire Administration, (USFA), under the umbrella of FEMA. Per USFA’s annual report, (2010) The United States Fire Administration (USFA) recognizes the challenges presented by the Nation’s fire problem, and continues its efforts to contribute to the safety of not only the residents of this Nation, but our firefighters and emergency responders and allied professionals as well. ( pg iii, para. ) USFA offers advance training and education in many areas for emergency preparedness, and according to the 2010 annual report, …continued to provide career and volunteer fire service education and training at the National Fire Academy (NFA) through a vast amount of courses and programs to include, but not limited to, fire prevention and suppression technologies, incident management, leadership and advanced managerial skills…

Since the creation of the USFA and its programs of public education and awareness initiatives, training, research, technology development, data collection and analysis, and partnering with other fire safety interests, the non-fire-service death and injury rates have improved steadily. USFA remains committed to providing a solid foundation for our fire and emergency services stakeholders in prevention, preparedness, and response. ( pg. iii, para. 9) Besides full-time staff, USFA and FEMA have disaster assistance employees on standby, who can be deployed when a disaster strikes.

According to FEMA, (2011), FEMA has 7,474 employees across the country working to support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve our capability to prepare for, protect against, respond to, recover from, and mitigate all hazards. All of these federal resources are ones that might be accessed by a local community experiencing a disaster, which is overtaxing local resources. These agencies also have resources available to help a community prepare before disaster strikes.

There are grants, which can be applied for, by local communities to help with training and staffing for fire prevention. Stanhope and Lancaster,(2008) remind us of the invaluable resources from Homeland Security, ” The DHS orks with first responders throughout the United States and through the development of programs such as the Community Emergency Response Team (CERT), trains people to be better prepared to respond to emergency situations in their communities”( pg. 60, para. 2). By having proper resources, being prepared for emergencies and having a plan, a local community can prevent the loss of life, while moving toward recovery faster. How Public Health Care Teams Can Enhance Personal Preparedness Public health care teams have partnerships with volunteer agencies, as well as law enforcement and government agencies for safety and disaster assistance. Because of these alliances, communities are better equipped to respond to an emergency.

Public health can increase the community’s awareness by providing education regarding emergency preparedness. Educating the public so they can be prepared for any disaster, will help people respond in an organized manner and reduce confusion and panic. Public health can help people prepare by conducting mock drills, as well as assisting people put together a personal disaster plan. Public health nurses can also help by providing education regarding specific ways for individuals and communities to prepare for emergency situations. Suggestions to Enhance Personal Preparedness There are many things that a person can do to enhance personal emergency preparedness.

The very first thing is to understand what risks exist in a person’s environment. Once risks are identified, then proactive and specific planning can occur. Individuals should have ready access to the following in case of an emergency; important documents such as insurance policies, home deeds, current medication lists, enough medications on hand for at least 10-to14 days, cell phones, battery operated radios, food, and water ( American Red Cross , 2012). In the case of wildfires, a home owner must be aware of their risks. Clearing ten to thirty feet of brush space around the home is the best defense according to FEMA, (2012), as well as having an outside water source.

Fire Wise, a project of the National Fire Protection Association, (2011), also provides homeowner safety suggestions, The Home Ignition Zone begins with at least30 feet of space immediately around the home and extending out as far as 100 to 200 feet depending on the characteristics of the surrounding forests or grasslands. Creating and maintaining the Home Ignition Zone reduces or eliminates ignition hazards presented by vegetation (by thinning or spacing, removing dead leaves and needles and pruning shrubs and tree branches) and combustible construction,(wooden porches, decks, storage sheds, outbuildings, swing sets and fences). WHY? Reducing ignition hazards improves the chances hat the structure will survive a wildfire…

Part of being prepared is understanding and taking responsibility for methods to stay safe; with fires, this includes taking steps to keep a home safe by understanding environmental planning and fire-safe landscaping. Another important aspect is to understand one’s limits, and plan emergency staffing resources appropriately. The Neighborhood hospital was understaffed, and had not planned for additional space for an overflow and large influx of patients, related to emergencies. Stanhope and Lancaster , (2008) cite Kowalczyk, (2004),in discussing the patient safety threat of understaffing for nurses,

In a follow-up report, Keeping Patients Safe: Transforming the Work Environment of Nurses, the IOM (2003) stated that nurses’ long work hours pose one of the most serious threats to patient safety, as fatigue slows reaction time, saps energy, and diminishes attention to detail. The group called for state regulators to pass laws barring nurses from working more than 12 hours a day and 60 hours a week—even if by choice. The hospital administration has announced they will be starting mandatory overtime immediately; add this to the already stressed nursing staff, and a recipe for unsafe practice may be the result.

The hospital would be serving their patients better if they requested assistance rom the local medical reserve corps; setting up a triage area to better determine the needs of the patients. Some beds could be set up at the senior center, local schools and/or outpatient clinics to care for those who did not have as acute needs as some others. One last suggestion, to help minimize risk would be to cancel the science fair event; this would serve to keep more people from venturing outdoors and breathing the smoke-filled air. Conclusion Emergencies and disasters happen when we least expect it; although some events are not controllable, we can predict risk, and then prepare for potential emergencies. Public Health has many different roles in emergency preparedness and disaster mediation.

One role is to provide education for communities to help people prepare individual plans, thereby minimizing risk from disasters. Another role is to organize and manage a response to emergencies, while effecting collaboration with other agencies and organizations. One of the keys to public safety is proactive preparation and education regarding approaches to minimize the risks from disasters. Part of this is conducting a mock emergency drill, prior to a real emergency occurring.

With knowledge, preparation and collaboration between community, state and federal levels of public health organizations, lives can be saved and property loss minimized when a disaster occurs. A community’s ability to recover faster, depends upon the proactive planning by public health when assisting the community.

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