34.1 Environmental Disasters

Water Disasters: Storms, Snow, Floods, and Tsunamis

Disasters involving water are some of the deadliest and most widespread disasters that can devastate the human race (Puryear & Gnugnoli, 2023). As nurses, the level of preparedness and understanding must be high in order to carry out duties properly. According to the National Weather Service (NWS), flash floods are the second-highest cause of death from meteorological disasters in recent years (NWS, 2022). Understanding how these disasters occur and what areas are most prone to them is paramount. For example, in Virginia, where heat-related ailments can be common in the summertime, 400 additional outpatient visits are required to care for heat-related illness along with seven thousand additional emergency department visits and two thousand hospital admissions each summer due to heat (Center for American Progress, 2023). Virginia hospitals use this information to ensure additional resources are ready each summer.

Thunderstorms are especially common in the United States. The United States experiences more thunderstorms than many other regions due to its unique geography (Borenstein, 2023). The country's geography channels warm, moist air from the Gulf of Mexico to collide with cool, dry air from the Rocky Mountains, creating unstable atmospheric conditions that are conducive to thunderstorms. The geography also serves as a mechanism to lift unstable air and cause thunderstorms to form. The entire United States can experience thunderstorms and the hazards that come with them, such as lightning, torrential rain, flash flooding, hail, damaging winds, and tornadoes. An important aspect of being prepared for such threats is listening to the information and guidance from the NWS and local meteorologists. Understanding the threat level on a given day and what can come with it is the first step in planning a response to such an event. This information is readily available on cell phones and on the NWS websites, such as the Storm Prediction Center. A battery-operated weather radio is essential for staying informed during severe weather. This information could be placed on a board so nurses have an idea what the threat is for the day on a regional level, and a television can be left on the local news.

Knowing when an area is under a watch or a warning for a particular hazard is also important. The difference between a watch and a warning is whether the hazard is imminent. For example, a tornado watch would be issued if the environmental conditions are favorable for tornadic development throughout the time period the watch is in place. A tornado warning would be issued if there is a storm with radar-indicated rotation or an observed tornado moving its way into the area.

Tropical storms and hurricanes can also cause immense and widespread problems. These storms not only have extremely strong winds and rain but can also spawn tornadoes and cause floods due to both heavy rain and storm surge, which is when water from the ocean is pushed ashore by heavy winds.

Snow and floods are similar in that the NWS and its partner agencies provide guidance and often establish command centers to coordinate communication for areas at risk from these hazards. Large amounts of snow can cause roadways to be blocked, making travel impossible. When the snow melts, there will be added risk because all the water can now cause flooding. Heeding expert advice and professional guidance is the best way to prepare for such disasters.

Floods can be caused by a multitude of factors. Floods can come in the flash flood variety, which is typically caused by an excessive amount of rain in a short time frame. Flash floods are dangerous due to how fast they come about (Roudbari et al., 2024). Floods can also come from a lot of precipitation being funneled into an area by high terrain. Understanding the terrain and susceptibility of the area to floods is another factor in being prepared. Floods can also be caused by geologic hazards such as landslides and tsunamis. Nurses in these areas should be prepared for the need to move patients to higher floors and to protect electrical equipment.

A tsunami is a geologic hazard that usually comes from shallow underwater earthquakes. Even weak earthquakes can cause devastating tsunamis. Knowing the course of action in an earthquake-prone area near a coast, such as the American West Coast, is paramount to keep people as safe as possible. Tsunamis can also be caused in smaller bodies of water by landslides. The largest theorized tsunami came from a landslide triggered by a massive earthquake, causing the face of a mountain to plunge into a lake, displacing a massive amount of water and forming a massive wave.

Weather disasters severely disrupt access to hospitals and can be life-threatening for at-risk community members. Hospitals may sustain physical damage that limits their ability to provide care, and facilities can become inaccessible due to blocked roads. Nurses should be aware of potential emergency staffing needs. This means the need to ensure coverage for all shifts, which may mean sheltering in place at the hospital. Staff are often trying to work under overwhelming resource strain, including loss of crucial resources like electrical power. People with pre-existing medical conditions can be in grave danger if their necessary medications, equipment, or home care are interrupted during a disaster. Patients should be educated on preparing a “grab-and-go” emergency kit for such situations.

Nurses should be aware of their organization’s emergency plan, including evacuation routes and shelter locations, and ensure windows and doors are secured (Puryear & Gnugnoli, 2023). Evacuation can be challenging for people with limited mobility. Even if people who are immobile are moved, many shelters are not able to accommodate complex medical needs. Evacuation drills are required by the Occupational Safety and Health Administration (OSHA) primarily for fire emergencies and other workplace hazards. States may have additional requirements for evacuation drills related to various emergencies, including severe weather and hazardous material spills, but these state-specific rules can vary.

Communication breakdowns further isolate the people who are in most need of help during a disaster, and the disruptions may have serious long-term consequences. Delayed care can lead to severe medical complications or even death. All of these effects and consequences will be amplified in populations with lower incomes and in medically underserved areas. Roads can be blocked or completely swept away, especially in these underserved areas where road quality may already be diminished. Food supplies can be tainted and leave communities at risk for starvation and the people affected can be hampered long term with emotional health problems and economic crises.

Land Disasters: Earthquakes, Landslides, and Wildfires

Earthquakes, landslides, and wildfires pose significant threats to life and property, often resulting in widespread damage. An earthquake is a geological disaster caused by collisions of tectonic plates. There are several regions of the world that are prone to earthquakes; however, they can happen anywhere. Earthquakes are very hard to predict, so it is difficult to predict when an area may be under threat. Understanding the regional threat of earthquakes determines the preparedness level required. Having an established disaster plan in place is one way to be prepared at all times for an earthquake. Being indoors in a sturdy building can mitigate any harm. When an earthquake occurs, a subsequent smaller and often weaker earthquake, called an aftershock, often happen.

Preparedness any time after the initial earthquake is crucial. Sometimes, earthquakes can trigger large landslides that can sweep away small buildings, trees, and large rocks into a running “river” of earth. If an area with high terrain experiences an earthquake, it is very likely that the shaking will dislodge rocks and create a landslide. The course of action when there is a landslide is to get to higher ground as quickly as possible. When an earthquake occurs or if heavy rainfall is forecasted, a landslide could be possible, and preparations should take place.

Wildfires can cause some of the most widespread damage of any natural disaster. A wildfire is most common in areas of drought and dry conditions where vegetation is present. Wildfires flourish in very dry and windy conditions; for example, in Alaska, the valleys of California, the Texas panhandle, and parts of the Southeast (Insurance Information Institute, 2020). The drier the vegetation is, the more likely it is for fire to start and spread. Windy conditions exponentially increase how fast and how far the fire spreads. Wildfires can spread hundreds to thousands of square miles in very short periods of time. Evacuation is the only way to escape these fires. The best way to be prepared is to listen for guidance from the NWS and local news agencies and be aware of a particular area’s risk for wildfires. In case of fire, nurses should be prepared for any evacuation orders and the course of action to protect patients.

Nursing Roles and Responsibilities

Nurses have many responsibilities when natural disasters strike, and must play a pivotal role in mitigating the impact on individuals and communities. Nurses are integral in disaster preparedness efforts. Nurses collaborate with interdisciplinary teams to develop and refine emergency response plans tailored to the specific risks posed by natural disasters. They assess community vulnerabilities, identify at-risk populations, and devise strategies to ensure swift and effective action when disaster strikes.

During the acute phase of an environmental disaster, nurses serve as frontline responders, providing immediate medical care and triage services. They possess the clinical expertise to assess and prioritize injuries, administer life-saving treatments, and stabilize patients for evacuation or transfer to higher levels of care. Nurses also fulfill critical roles in establishing and managing temporary medical shelters. They set up triage areas, organize medical supplies, and coordinate with other health-care professionals and emergency responders to streamline patient care, providing continuous monitoring, treatment, and emotional support to patients, and addressing the physical injuries, psychological trauma, and emotional distress that often accompany environmental disasters.

In the aftermath of an environmental disaster, nurses continue to play a vital role in long-term recovery efforts. Nurses collaborate with public health agencies, community organizations, and government entities to assess the health needs of affected populations and implement targeted interventions. Nurses advocate for at-risk groups, ensuring equitable access to health-care services, medications, and support systems. They also contribute to ongoing surveillance and monitoring efforts to detect and mitigate potential health threats arising from environmental hazards, such as contaminated water sources or infectious disease outbreaks. Importantly, nurses need to be aware of their own needs and make sure they take care of their mental health during an environmental disaster. Nurses can deal with trauma and burnout from these disaster events and it is important they take care of themselves so that they can take care of patients as effectively as possible. From proactive preparedness initiatives to hands-on clinical care and community advocacy, nurses’ unwavering commitment to serving humanity during times of environmental disaster embodies the core values of the nursing profession and underscores the indispensable contributions of nurses to public health and safety.