Community nursing discussion

Chapter 28 Natural and Man-Made Disasters Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Disaster Definitions  A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. ➢ ➢ ➢ Mass casualty involves 100+ individuals Multiple casualty involves 2 to 99 individuals Casualties can be classified as a direct victim, indirect victim, displaced person, or refugee Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Types of Disasters    Natural disasters Man-made disasters Combination disasters ➢ NA-TECH (natural/technological) disaster: a natural disaster that creates or results in a widespread technological problem Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Types of Disasters (Cont.) (from Textbook, Box 28-1) Natural Disasters           Avalanches Blizzards Communicable disease epidemics Droughts, wildfires Earthquakes, tsunamis Hailstorms Heat waves Hurricanes Tornados, cyclones Volcanic eruptions Man-Made Disasters           Terrorism Civil unrest (riots) Explosions, bombings Fires Structural collapse (bridges) Airplane crashes Toxic or hazardous spills Mass transit accidents Pollution Wars Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Acts of Terrorism Terrorism is   “the unlawful use of force and or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.” (FBI, 2013) “is premeditated, politically motivated violence perpetrated against noncombatant targets by subnational groups or clandestine agents.” (CIA, 2013) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Weapons of Mass Destruction    Any weapon that is designed or intended to cause death or serious bodily injury through release, dissemination, or impact of toxic or poisonous chemicals, or their precursors Any weapon involving a disease organism (biological agents)

Any weapon that is designed to release radiation or radioactivity at a level dangerous to human life (chemical agents) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Characteristics of Disasters       Frequency Predictability Preventability/mitigation Imminence Scope and number of casualties Intensity Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Prevention in Disasters  Primary prevention ➢ Aimed at preventing the occurrence of a disaster or limiting the consequences when the event itself cannot be prevented (mitigation) ➢ Nondisaster stage: period before a disaster occurs ➢ Predisaster stage: actions taken when a disaster is pending Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Prevention in Disasters (Cont.) ➢ Nondisaster activities include: • Assessing communities to determine potential disaster • • • • • hazards Developing disaster plans at local, state, and federal levels Conducting drills to test the plan Training volunteers and health care providers Providing educational programs of all kinds Developing risk maps and resource maps Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Prevention in Disasters (Cont.) ➢ Predisaster activities include: • Notification of the appropriate officials • Warning the population • Advising what response to take  voluntary or mandatory evacuation Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Prevention in Disasters (Cont.)  Secondary prevention ➢ ➢ ➢ Implemented once the disaster occurs Aimed at preventing further injury or destruction “Safety before search and rescue.” Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Prevention in Disasters (Cont.)  Tertiary prevention ➢ Focuses on recovery and restoring the community to previous levels of functioning and its residents to their maximum functioning ➢ Aimed at preventing a recurrence or minimizing the effects of future disasters through debriefing meetings to identify problems with the plan and making revisions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Nurses Need to … … be involved in all stages of prevention and related activities … educate others about disasters and how to prepare for and respond to them … keep up to date on latest recommendations and advances in life-saving measures Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Questions Nurses Should Ask 1. What kind of disasters threaten the 2. 3. 4. 5. communities where I live? What injuries should I expect from different disaster scenarios?

What are the evacuation routes? Where are shelters located? What warning systems are used so I can respond effectively, personally, and professionally during different types of disasters? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Disaster Management   A collaborative interdisciplinary team effort is needed between a network of agencies and individuals. Develop a disaster plan. ➢ ➢ ➢ Communities can respond more quickly, more effectively, and with less confusion. Ensures that resources are available. Delineates roles and responsibilities of all personnel and agencies, both official and unofficial. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Governmental Responsibilities  Local government (first responders) ➢  State government (Office of Emergency Management) ➢  Responsible for the safety and welfare of its citizens. Involved when a disaster overwhelms the local community’s resources. Federal government (Department of Homeland Security and CDC) ➢ A single department focusing on protecting the American people and their homeland Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 U.S

Department of Homeland Security (DHS)  DHS has three primary missions: ➢ ➢ ➢  Lead the unified national effort to secure America Prevent and deter terrorist attacks Protect against and respond to threats and hazards to the nation DHS goal (2011): Sets the “vision for nationwide preparedness” ➢ Identifies the core capabilities and targets necessary to achieve preparedness across five mission areas: Prevention, Protection, Mitigation, Response, and Recovery. ➢ Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 NIMS  NIMS (National Incident Management System) provides a systematic, proactive approach for all levels of governmental and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters. – Federal Emergency Management Agency (FEMA) (2012) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 FEMA  Mission is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards. ➢ ➢ Established National Terrorism Advisory System • Threat alert: elevated or imminent threat FEMA published in-depth guide for citizen preparedness: Are You Ready? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Partnerships in Disasters       Department of Homeland Security (DHS) Federal Emergency Management Agency (FEMA) Department of Health and Human Services/ Centers for Disease Control and Prevention Public Health System (PHS) American Red Cross (ARC) Other local, state, and federal agencies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Disaster Management Stages     Prevention stage Preparedness and planning stage Response stage Recovery stage Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Prevention Stage  Identify potential disaster risks. ➢  Educate citizens regarding what actions to take to prepare for disasters. ➢  Create risk maps Individual, family, and community level Develop a plan for meeting the potential disasters identified. ➢ Create resource maps Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Community Risk Map (from Textbook, Figure 28-1) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Community Resource Map (from Textbook, Figure 28-2) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Preparedness/Planning Stage: Individual and Family Preparedness     Training in first aid Assembling a disaster emergency kit Establishing a predetermined meeting place away from home Making a family communication plan Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Preparedness/Planning Stage: Community Disaster Planning  Plans must include: ➢ ➢ ➢   Authority Communication Logistical coordination of: • Supplies and equipment • Human resources • Evacuation and rescue Plans must be dynamic and change as needed. Plans must be tested in different disaster scenario drills. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Disaster Planning Principles (from Textbook, Box 28-8) 1. 2. 3. 4. 5. 6. 7. 8. 9. Measures usually taken are not sufficient for major disasters. Community nursing discussion

Plans should be adjusted to people’s needs. Planning does not stop with development of a written plan. Lack of information causes inappropriate responses by community members. People should be able to respond with or without direction. Plans should coordinate efforts of the entire community, so large segments of the citizenry should be involved in the planning. Plans should be linked to surrounding areas. Plans should be general enough to cover all potential disaster events. As much as possible, plans should be based on everyday work methods and procedures. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Disaster Planning Principles (Cont.) (from Textbook, Box 28-8, Cont.) 10. Plans should specify a person’s responsibility for implementing segments by position or title rather than by name. 11. Plans should develop a record-keeping system before a disaster occurs, regarding: • Supplies and equipment • Records of all present at any given time (to account for everyone and to identify the missing) • Identification of victims and deceased, conditions and treatment documented, and to which facility victims are sent 12. Backup plans need to be in place for the following: • Disruption of telephone and cell phone lines • Disruption of computer data (should be downloaded weekly and stored off site) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Response Stage   Response stage begins immediately after the disaster incident occurs. May include: ➢ Shelter in place ➢ Evacuation ➢ Search and rescue ➢ Staging area ➢ Disaster triage Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Areas of Operation in Disaster Response Figure 28-3 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Disaster Triage  START triage system ➢ ➢ ➢ “Simple Triage And Rapid Treatment” Used in multicasualty or mass casualty incident Triage of injured person should occur in less than 1 minute based on: • • • ➢ ➢ ➢ Respirations Perfusion Mental status Uses people with minor injuries to assist Person is tagged with a colored triage tag Victims moved to the treatment area Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 31 START Color-Coded Triage Tag Green = walking wounded Yellow = systemic but not yet life-threatening complications Red = life-threatening conditions that can be stabilized and have a high probability of survival Black = deceased or injuries so extensive that nothing can be done to save them Figure 28-4 Source: http://www.mettag.com. Reprinted with permission.

Hazmat tag = contaminated Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Psychological Triage  Four keys to gauging mental health impact: ➢ ➢ ➢ ➢  Extreme and widespread property damage Serious and ongoing financial problems High prevalence of trauma in the form of injuries, threat to life, and loss of life When human intent caused the disaster In addition, panic during the disaster, horror, separation from family, and relocation or displacement may play a part Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 33 Public Health Activities  While search and rescue is going on … ➢ Surveil for threats (e.g., contaminated water, vectors, and air quality). ➢ Disseminate data on what has been found. ➢ Relate health information to officials, the media, and the public as appropriate. ➢ Gather epidemiological information. ➢ Allocate resources and work to prevent further adverse health problems. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Responses to Disasters  Community ➢ ➢ ➢ ➢ Heroic phase Honeymoon phase Disillusionment phase Reconstruction phase  Individual ➢ Cognitive ➢ Emotional ➢ Physical ➢ Behavioral ➢ PTSD Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Recovery Stage   Begins when the danger from the disaster has passed. All local, state, and federal agencies are present in the area. ➢ Help victims rebuild their lives ➢ Restore public services ➢ Cleanup of damage and repair begins ➢ Evaluation and revision of the disaster plans ➢ Understand the financial impact Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 36 Chapter 22 Substance Abuse and Misuse as Community Health Problems Definitions of Substance Abuse • Substance abuse: the use of any drug (alcohol, street drugs, prescription and over-the-counter medications) that results in a loss of control over the amount taken and when it is taken • Dependence or addiction: present when there are phy siological symptoms that occur with withdrawal of the substance Scope of Substance Abuse • Illicit drug use • Use of alcohol Community nursing discussion

• Use of Tobacco Impact of Substance Abuse on Soci ety • • • Preventable morbidity and mortality Healthcare costs Costs to society Impact of Substance Abuse on the Individual • • • • • • • • Loss of job Divorce Health problems (acute and chronic) Nutritional deficiences Low self-esteem Depression Anxiety Death Risk Factors for Substance Abuse • • • • Society’s influence The family’s influence The workplace’s influence Personal factors Nursing Assessment • Nurses’ attitude self-assessment • Drug history • Recognizing the signs of substance abuse Interventions • Society’s response – Healthy People 2020 – Primary prevention – Secondary prevention – Tertiary Prevention • Interventions with special populations Community nursing discussion