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Population Health for Nurses

32.4 The Disaster Management Cycle

Population Health for Nurses32.4 The Disaster Management Cycle

Learning Outcomes

By the end of this section, you should be able to:

  • 32.4.1 Describe the disaster management cycle.
  • 32.4.2 Explain the nurse’s role in the disaster management cycle.
  • 32.4.3 Discuss how community partners work together to prevent, prepare for, respond to, and recover from disasters.

A planned, systematic approach to disaster management allows community members, health care providers, emergency response agencies, and community organizations to respond to disasters and mass causalities effectively and efficiently. Community assessment identifies potential disasters, enabling planning to prevent, prepare, and respond to reduce their impact. Nurses play an integral role in all phases of the disaster management cycle. Multisector, interprofessional collaboration enhances disaster prevention, preparation, and response.

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.

The disaster management cycle is depicted as 4 arrows that form a circle. The arrows are labeled Response, Recovery, Mitigation, and Preparedness. Outside of the circle at the top is a starburst labelled Disaster. A narrow arrow points from Disaster to the words After The Event near the response and recovery portions of the cycle. Another arrow circles from After The Event to the words Before The Event near the mitigation and preparedness portions of the cycle.
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.

Emergency Preparedness Home Tour

Personal and family preparedness is a professional nurse disaster competency. In this video, a city councilor from Gresham, Oregon, describes how families can prepare their homes in case of an emergency or disaster.

Watch the video, and then respond to the following questions.

  1. How does the family plan for disaster within their home?
  2. How does your personal preparedness home plan compare to the video?

For more information on developing a personal preparedness plan, visit the American Red Cross Disaster Preparedness Plan or Minnesota Department of Public Safety website on Personal and Family Preparedness.

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).

Healthy People 2030

Emergency Preparedness

These Healthy People 2030 objectives aim to improve emergency preparedness and response by building community resilience. The following general emergency preparedness objectives are in the developmental stage:

  • Increase the proportion of parents and guardians who know the emergency or evaluation plan for their children’s school — PREP-DO1
  • Increase the proportion of adults who prepare for a disease outbreak after getting preparedness information — PREP-DO2
  • Increase the proportion of adults who know how to evacuate in case of a hurricane, flood, or wildfire — PREP-DO3
  • Increase the proportion of adults who have an emergency plan for disasters — PREP-DO4

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.

Client Teaching Guidelines

Disaster Preparedness

Community education for disaster preparedness includes:

  • Create a family preparedness plan that includes an evacuation plan. Review the plan annually.
  • Determine a family communication plan that includes an emergency meeting place. How will you communicate if phone lines and towers are not working?
  • Assemble a disaster kit. Inventory the kit at least annually, replacing expired items.
  • Assemble an emergency kit for your vehicle.
  • Store important documents in a waterproof, portable container.
  • Make a plan for your pets and animals.
  • Secure property prior to a disaster.

(See U.S. Department of Homeland Security, 2023.)

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.

Hurricane Tabletop Exercise

Tabletop exercises are discussion sessions where community members discuss their roles and responses during a specific emergency or disaster. This video discusses the benefits of conducting tabletop exercises.

Watch the video, and then respond to the following questions.

  1. Why does this community complete hurricane tabletop exercises annually?
  2. What are the benefits of testing the emergency plan using a tabletop exercise?

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.

Unfolding Case Study

Part A: Disaster Management

Read the scenario, and then answer the questions that follow.

Juanita, a public health nurse on the Florida Coast, is a member of the disaster management team. In anticipation of the approaching hurricane season, Juanita reviews disaster prevention and mitigation plans for the community. She assesses the community for the most vulnerable individuals (those with physical and mental disabilities) and maps their locations. She also plans nursing interventions to mitigate the effects of the hurricane.

Juanita meets with the multiagency, interprofessional team during a tabletop exercise on hurricane disasters. She shares the location of the most vulnerable individuals in the community because they may require well-being checks or evaluation during power and phone outages. She provides input from a nursing perspective on potential sheltering locations, shelter resource needs, and the triage and transport process. Juanita suggests including surrounding communities in the hurricane disaster plan to prepare for increased population and health needs in their communities due population displacement before and following hurricane landfall.

1.
What is another vulnerable population that may require well-being checks during emergency events and disasters?
  1. Older adults
  2. Single parents
  3. Persons with substance-use disorder
  4. Young adults
2.
Which nursing intervention would be appropriate to mitigate the effects of a hurricane disaster?
  1. Conduct a simulation to practice triage in mass casualty situations.
  2. Teach classes on family safety planning prior to hurricane season.
  3. Draw a shelter blueprint to prepare for mass food, water, and health needs.
  4. Lead a tabletop exercise on hurricanes with health department staff.

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.

Local Partners
  • Immediate response to local disasters
  • Establish preparedness plans
  • Conduct mitigation efforts
Emergency response coordinators
  • Establish local emergency action plans
  • Identify potential hazards within the community
  • Develop mitigation plans
  • Coordinate emergency response
Medical and mental health providers including nurses
  • Triage, assessment, and treatment of victims
  • Participate in mitigation and preparedness activities
  • Ensure adequate resources for medical and mental health care
  • Educate on mitigation, preparedness, and risks following disaster
Emergency medical services
  • Provide immediate response to disaster events
Law enforcement
  • Provide immediate response to disaster events
  • Assist with scene safety, response, and logistics
  • Educate on disaster prevention, preparedness, and response
Fire services
  • Provide immediate response for fire suppression, emergency medical response, and hazardous materials response
  • Assist with scene safety
  • Educate on fire prevention and response
Medical Reserve Corps
  • Assist in response to community health needs by offering medical support, shelter support, surge support, dispensing efforts, first-aid response, and community outreach
Hospitals and health care services
  • Provide treatment during disaster
  • Educate on mitigation and preparedness
Humanitarian organizations
  • Assist with sheltering, transportation, food, water, and resource distribution
Faith-based organizations
  • Assist with sheltering, transportation, food, water, and resource distribution
  • Provide spiritual resources
State Partners
  • Provide recommendations for and approval of local emergency preparedness plans
  • License professionals
  • Assist in disaster response and recovery when local resources are exhausted
State National Guard
  • Assist with transportation, communications, public works and engineering, emergency management, mass care, search and rescue, and hazardous materials management
State Public Health Associations
  • Approve local emergency preparedness plans
  • Provide training exercises and education on disaster management
National and Federal Partners
  • Recommend guidelines for disaster management
  • Assist in disaster response and recovery when National Emergency declared or when state resources are exhausted
U.S. National Response Team (NRT)
  • Provides assistance, resources, and coordination in response to land, air, and water pollution incidents
U.S. Environmental Protection Agency (EPA)
  • Provides leadership and assists with prevention and preparation for chemical emergencies
  • Responds to environmental disasters
  • Educates about chemical hazards
National Guard
  • Assists with transportation, communications, public works and engineering, emergency management, mass care, search and rescue, and hazardous materials management
Federal Emergency Management Agency (FEMA) National Incident Management System (NIMS)
  • Coordinates response of federal agencies to disasters
  • Provides guide for All-Hazards Emergency Operations Planning
  • Educates on NIMS and the National Response Framework (NRF)
Department of Health and Human Services (HHS)
Homeland Security
  • Provides national security from threats (aviation and border security, emergency response, cybersecurity, terrorism)
Centers for Disease Control and Prevention (CDC)
  • Educates on health and health threats, including disaster preparedness and response
  • Responds to health threats
  • Investigates disease outbreaks
American Red Cross
  • Private, volunteer agency
  • Provides immediate disaster relief (shelter, food, health services)
Table 32.10 Partners and Organizations Involved in Disaster Management
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