32.4 The Disaster Management Cycle

Phases of the Disaster Management Cycle

To establish a plan for disasters, the nurse must understand the phases of the disaster management cycle (Figure 32.6). The public health/community health nurse has an important role in each phase to promote optimal health outcomes for the people involved.

Figure 32.6 The disaster management cycle has four phases. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Mitigation, an action to prevent or reduce the cause, impact, or consequences of a disaster, is the first phase of the disaster management cycle. A community assessment identifies community risk factors. This includes determining what natural disasters the community is likely to face. For example, communities geographically situated in coastal regions are at risk for hurricanes or tsunamis. This also includes identification of potential targets of terrorist attacks and potential human-made disasters, such as the release of dangerous chemicals from a factory following an explosion. Community programs focused on preventing the occurrence and mitigating the impact of disasters are developed and implemented (Homeland Security, 2015). For disasters that cannot be prevented, such as earthquakes, hurricanes, and tornadoes, efforts may focus on mitigating the effects of the event on the community. Examples of mitigation include placing sandbags along a river to decrease the amount of floodwater, constructing levees or barriers to prevent or control flooding, boarding windows before a hurricane makes landfall, and improving building infrastructure to reduce the risk of damage during an earthquake.

Preparedness is the second phase of the disaster management cycle. It includes planning, training, and educational activities to address the consequences of disasters that cannot be mitigated. Preparedness is a continuous state of planning for rapid response when a disaster occurs. Task forces made up of community representatives from the local government, health care providers, social services providers, police and fire departments, major industries, local media, schools, and citizens’ groups form to ensure that each area of the community knows its role and has a plan in place for when a disaster occurs. In the preparedness phase, responding personnel from each agency are trained. This training includes drills or simulations of mock disasters. Public education is key in providing community members with information on how they can best prepare their families and whom to contact if they are directly impacted by a disaster (FEMA, 2021). The disaster preparedness plan includes what to do in case of disaster, where to go, who to call for help, identifying home vulnerabilities, and accumulating disaster supplies/equipment.

Disaster response is the third phase of the disaster management cycle. Disaster response is the execution of the disaster plan when a disaster event occurs. Disaster response management is a local community responsibility that begins before the announcement of an official disaster declaration (Klein & Irizarry, 2022) and continues for the first 72 hours (deAnda et al., 2022). If local resources are depleted after 72 hours and cannot be managed, the Stafford Disaster Relief and Emergency Assistance Act allows the state governor to request a disaster declaration from the president of the United States. This declaration mobilizes federal resources to assist local agencies in the aftermath of a disaster (deAnda et al., 2022).

Disaster recovery, the fourth phase of the disaster management cycle, begins during the response phase once the threat to human life and infrastructure has passed. Recovery efforts aim to return a community to some degree of normal predisaster functioning (Klein & Irizarry, 2022). The simultaneous work of rebuilding and resuming regular operations and activities may require a prolonged period. Disaster recovery includes rescue work to provide relief, primarily immediate medical care, food and water, clothing, and shelter (Polcarová & Pupíková, 2020). Once people’s immediate needs are met, restoring public services such as communication and transportation begins the process of returning to normalcy. Rebuilding community infrastructure may be a long-term course but may also present improvement opportunities (Polcarová & Pupíková, 2020).

The Nurse’s Role in the Disaster Management Cycle

The ANA (2016) considers disaster preparedness and response a basic competency of nursing practice. While most nurses may not have extensive experience in disaster response, they are expected to have minimum knowledge about disaster management. They participate in preparedness planning and training drills, and they have skills and abilities to provide client care and community support during a disaster. Community health nurses collaborate with health care professionals and partner with health system leaders, individuals, and families to improve population health outcomes and promote community resiliency when disasters occur (Chegini et al., 2021).

Nurses are an important part of all phases in the disaster management cycle. Understanding the inherent risks a community faces for different types of disasters is critical in the mitigation phase. If a community is at a higher risk of a particular type of disaster, then more time and resources can be focused on activities that will prevent losses. For example, community health nurses who work in areas at risk for tropical weather may need to spend more time mitigating the effects of hurricanes than the risk of forest fires. Public safety education helps people in the community understand the potential hazards and effects of the disasters for which their community is at greatest risk. Community education on strategies to mitigate hazards and how to respond in case of a disaster raises individuals’ awareness and increases the likelihood that they will develop a disaster plan. Families should know what to do, who to call, and where to go in emergencies. When individual community members are generally disaster-aware, they can immediately implement the personal disaster response plan as needed. The nurse plays a key role in educating community members on disaster preparedness.

The nurse must be involved in preparedness activities and participate in disaster management education and training from the beginning of nursing education programs (ANA, 2016). Many organizations provide practicing nurses opportunities for further education to build the skills to prepare for and respond to emergencies. The FEMA Emergency Management Institute has a curriculum of disaster preparedness and response online courses available to the public free of charge at this link.

Collaboration with federal, state, and local relief agencies and organizations is critical in preparedness activities. Organizations like FEMA, the American Red Cross, state officials, and local emergency medical services come together to practice disaster response. Mock drills are simulation exercises that are regularly conducted to ensure community members and responders have practiced how to respond appropriately in disasters. Nurses should help plan and participate in these mock drills that simulate the type of disaster the community is most likely to have. Tabletop exercises are also useful for frequently reviewing disaster policies and procedures.

As care providers, nurses are often among the first to respond to health care needs in disaster situations. Lifesaving actions, injury treatment, and minimizing the effects of the disaster are the priority. Immediate needs such as medical treatment, shelter, food, water, and psychological support for survivors are the primary focus. The COVID-19 pandemic brought nursing disaster response to the forefront. Nurses worked tirelessly in their community hospitals, providing client care at the bedside, and the need for nurses to provide client care on the front lines was greater than the number of nurses available in many areas. In January 2020, the CDC activated the Incident Management System in response to the COVID-19 crisis. The CDC and Agency for Toxic Substances and Disease Registry Nurses’ Work Group (CNWG) helped to distribute and meet requests for nurse deployments to support the COVID-19 response (Zauche, 2022). The group used an Emergency Operations Management System application to track the work hours of those who contributed to the response. Among 190 CNWG members, 146 (76.8 percent) were deployed to work between January 21, 2020, and September 18, 2021. Combined, they recorded more than 24,600 days and nearly 198,000 hours on the response. Nurses worked in local facilities and with state public health agencies and departments throughout the pandemic as policy experts, contact tracers, researchers, epidemiologists, nurse consultants, and client advocates (Zauche, 2022).

Nurses also have a role in helping the community return to normalcy in the recovery period. They work collaboratively across disciplines to restore health care to optimal operations along the recovery continuum, adjusting according to the community’s needs. Nursing assessment and intervention during the recovery stage include monitoring and screening for communicable and infectious diseases, educating on water and food safety, educating on cleanup and disposal of debris and deceased livestock/animals, eliminating safety risks, and screening and treatment for mental health issues. Nurses have been essential in the post-pandemic phase of the COVID-19 pandemic. Nurses led the way in vaccine education, distribution, and coordination of administration in vaccine clinics. These efforts were essential to reestablishing health care to its modified baseline, and they have been active participants in creating new policies and practices to help prevent a resurgence.

Community Collaboration and Disasters

With the rising incidence of disasters, it is essential that public health professionals engage internal and external partners to promote community resilience and return to normalcy. Disasters present complex challenges for which no single discipline, agency, organization, or jurisdiction can or should bear sole responsibility (Association of Public Health Nurses [APHN], 2014). Community resilience after disasters is dependent on coordinated care and resource distribution. To gain the respect and confidence of the public, local agencies and leaders must manage disaster response and collaborate effectively to achieve optimal outcomes for the community (Charney et al., 2018).

Multisector, interdisciplinary collaboration is necessary at the community level during each stage of the disaster management cycle. Most often, the public health agency leads prevention and preparedness efforts within a community. Community partners who respond to and are affected by disasters are invited to participate in disaster management activities. This includes emergency response coordinators; emergency department managers; epidemiologists; nurses; emergency medical services; law enforcement; fire services; academic institutions; Medical Reserve Corps; private businesses; faith-based organizations; humanitarian organizations; nonprofit organizations; medical, health, and behavioral providers; and other community-based organizations (RHIhub, 2023). The disaster management team collaborates to assess the community for risk factors, plans efforts to mitigate disaster effects, and prepares for potential disaster through tabletop exercises and disaster simulations. Prevention and preparedness activities identify areas of strength, accessible resources, and areas for improvement.

The disaster management team utilizes the NIMS framework and ICS during disaster response and recovery to establish leadership, organize resources, and communicate effectively. When local resources are depleted, state partners, such as the National Guard, state emergency management agency, state health department, and governor’s office, and federal partners, such as FEMA, National Disaster Medical System, Environment Protection Agency, and U.S. Department of Health and Human Services Incident Response Coordination Team, may join disaster response efforts. Table 32.10 describes the role of various disaster response organizations and partners.