- Read the case
study. Answer the questions at the end of the case study
and click on the submit button to have your answers checked. You
will have the opportunity to register for continuing education
credit if you score 80% or higher.
- At any time in the case study you
may review the references cited. References available
online are indicated by an underline. To access simply click on
the article.
- Acrobat
Reader may be needed to view some links in this case study.
- The web
links were checked and verified when this case study was published.
- Please report
broken links to onlinece@stti.iupui.edu.
Introduction
to the case:
Four
nurse colleagues, all from different health care settings, meet weekly
for lunch. Anne is a family nurse practitioner who has elementary-age
children and sees clients part time in a large family practice medical
office. Beth is a BSN-prepared nurse who works full time in a large
community hospital emergency department. Claire is a doctorally-prepared
nurse who is a full professor of child psychiatric nursing at the
city university. Dawn is a BSN-prepared nurse who works part-time
in home health care, volunteers with hospice, and has married children
who live out of state.
Following the September 11, tragedy their conversations frequently
focused on what their response responsibilities should be in the future
for a WMD/T attack or any other large-scale disaster. They admitted
that family members, neighbors, clients, and patients have asked them
about their role as nurses, but they were unsure just how to answer.
As one of the most trusted
professions in America, nurses are uniquely positioned to provide
information regarding disaster preparedness to the community. Additionally,
their special knowledge, skills, and abilities make them key providers
of disaster relief services, especially in relation to meeting the
health needs of victims and workers.
After a couple weeks of being frustrated at their lack of knowledge
Anne, Beth, Claire, and Dawn decided to prepare themselves to address
the concerns and answer the questions of their family members, neighbors,
and clients, or at least direct them to appropriate resources. Dawn
volunteered to search the Web for resources and information. Two weeks
later, Dawn arrived at lunch with a folder full of papers. The nurses
were absolutely amazed at the amount of information Dawn had gathered!
What
is a Disaster?
While numerous definitions of disaster
exist, Noji (1997) suggests that health care providers should define
disaster based on how it impacts health and health services. From
a health care standpoint, the type and timing of a disaster event
are predictors of the types of injuries and illnesses that occur.
In the United States, disasters for which there are periods of prior
warning, such as hurricanes and slow-rising floods, generally tend
to have fewer injuries and deaths during the impact
phase. Those disasters with little or no advance notice, such
as many WMD/T events or natural disasters such as earthquakes, will
often have more casualties, since victims have little time to make
preparations or to evacuate the endangered area before disaster
strikes. Specific injuries and illnesses will depend on the type
of disaster. Those with warnings carry their own dangers, since
individuals can be injured attempting to prepare for the disaster
or while evacuating. In the post-disaster phase, the threat shifts
to clean-up injuries, which can be quite common after widespread
disasters such as hurricanes. While communicable disease outbreaks
following disasters are not common in the United States (Noji, 1997),
chronic
health conditions (such as cardiovascular disease and respiratory
problems) can be aggravated. Stress-related
symptoms can also occur during any phase of a disaster.
Public
Health Impact:
Disasters have the potential to significantly
affect the public health of a community. While medical facilities
can sustain direct physical damage from a disaster, access to medical
care can also be disrupted due to road closures, traffic jams, gasoline
shortages, phone and utility outages, overworked health personnel,
and other problems. Resources, such as food, water, and medicines,
may be depleted or unable to be accessed due to infrastructure damage.
Rumors may be rife during this time, easily started yet difficult
to stop. Disasters also have a significant psychological impact,
with communities and individuals moving through discrete psychological
stages post-disaster.
Response
Protocols:
When a WMD/T or other significant disaster
occurs, the first response will occur at the local level with the
mobilization of the Emergency Medical System (EMS), police, fire,
and other identified responders. Hospitals, (American
Hospital Association and Joint
Commission on Accreditation of Health Care Organizations) medical
facilities, and public health agencies will activate their disaster
plans; the county or city Emergency Operations Center (EOC) will
open; and the American Red Cross and other voluntary agencies will
respond. These local activities are mirrored at the state level,
where the state EOC will be activated and staffed by state emergency
management and representatives from various state agencies (such
as public health) and the American Red Cross. Large-scale disasters,
such as might occur with a WMD/T attack, will also result in a response
by Federal Emergency Management Agency (FEMA)
and will likely involve activation of the National
Response Plan (NRP)
Initial health response activity will come from local health care
providers and facilities as well as public health agencies. State
health agencies will quickly become involved to the extent called
for in the state disaster plan. On a national level, the Department
of Health and Human Services is responsible for the health
and medical portion of the FRP and will coordinate the provision
of federal health and medical assistance to supplement the efforts
of the affected state and local governments. One aspect of the federal
health response is the National
Disaster Medical System (NDMS). The American
Red Cross and other voluntary agencies and organizations also
provide assistance. Although the Red Cross is the only voluntary
organization named in the FRP, its activities are not dependent
upon activation of the FRP. The Red Cross provides a broad spectrum
of assistance during a disaster, including food, clothing, shelter,
health services, and mental health services.
Nurses can be optimally prepared for a disaster of any type by being
aware of community hazards and vulnerabilities, as well as being
familiar with the community health care system and its level of
preparedness.
It is essential that nurses have a personal and family
disaster plan – it’s difficult to provide care to others when
one is concerned about the safety of one’s family.
Nurses should be familiar with the disaster plan at their workplaces,
including their role in its execution. It is also important to increase
one’s knowledge base, especially in relation to bioterrorism,
since nurses may be called upon to educate patients and community
members.
Finally, volunteer
nurses are always needed by the Red Cross and other community
agencies, and the best time to sign on as a volunteer is before
a disaster strikes, while there’s time to be appropriately oriented
and have one’s license and credentials verified.
Numerous resources exist for nurses who wish to become better prepared
to respond to disaster events such as terrorist attacks. For information
on personal and community preparedness, consider obtaining community
disaster education materials from the American Red Cross or
other
organizations. One can also contact emergency management to
review a local community’s disaster plan to determine hazards, the
role of various agencies and organizations, and other key information.
It’s also imperative that every nurse be familiar with his or her
employer’s disaster plan. Health information may also be easily
obtained, although one must be sure that the information
source is reputable, especially if it involves WMD/T. Nurses
can take advantage of continuing education offerings, including
seminars, conferences, and online or printed journal articles. Organizations
such as the Red Cross also provide education/training opportunities.
Finally, nurses should realize that they will be viewed as potential
sources of accurate information by their families, friends, and
communities, and should take steps to become as knowledgeable as
possible about disaster preparedness and response.
Nurses’
Response and Plans:
Though delighted at the quality of the information, the nurses initially
were overwhelmed by the quantity and scope! Then Beth quoted, “Let’s
divide and conquer.” They each decided to formulate a manageable
action plan based on their own nursing expertise, employment situation,
and family needs and then utilize the relevant information.
Anne said, “I am interested in plans and preparations for families.
I could put information in a brochure or flier and distribute it
at the family practice clinic -- and maybe through my children’s
school parent teacher organization.”
“Great idea. Don’t forget your neighborhood organization. And I’d
like copies to share with my grown children and their families,”
said Dawn.
“I want to divide my energy between my place of employment and my
community,” said Beth. “I know the hospital emergency department
will be overwhelmed. I’ll offer to look into the hospital’s disaster
plan – see if it needs updating and if the staff needs in-service
training on the policies and procedures. In addition, I’d also like
to do something in the community at large.”
“Why not talk to the American Red Cross about recruiting nurses
from your hospital for the emergency response team?” suggested Claire.
“I am going to contact members of my school’s curriculum committee
and see if the nursing courses need to be included or updated on
disaster preparedness and response. And I’ll contact the leaders
of the student nurse association about the American Red Cross opportunities
for student nurses.”
“Would you also find information about the psychological impact
of disasters on children and families? I would like to add that
to the information I put together for parents,” said Anne.
Claire agreed to that. She is going to call the mayor’s office and
inquire about the plans the city government has for disaster preparedness
and response. She said she would be willing to volunteer if assistance
is needed.
Dawn said that she will show Anne’s family disaster planning information
to her managers at the home health care agency and hospice and anticipates
that they will distribute it to their clients. She will offer to
provide in-service training for the staff at both of the agencies
about the effects of a disaster on chronic health conditions. Her
neighbor is a parish nurse, and Dawn will offer to include her in
all her plans and activities.
“Let’s all talk to our nurse managers about arranging continuing
education for our co-workers on disaster preparedness and management.
So much valuable information is available online, we can encourage
the facilities we work in to make it available to every nurse employee,”
suggested Beth. “And let’s meet for lunch next week to see how we
are doing.”
References
American Academy of Pediatrics (n.d.). Children,
terrorism, & disasters. Retrieved November 5, 2002, from http://www.aap.org/terrorism/index.html.
American Academy of Pediatrics (2004). Family readiness kit. Preparing
to handle disasters. Retrieved January 14, 2004, from http://www.aap.org/family/frk/frkit.htm.
American Medical Association (2004). Bioterrorism articles. Journals
of the American Medical Association. Retrieved January 14, 2004,
from http://pubs.ama-assn.org/cgi/search?fulltext=bioterrorism&submit.x=16&submit.y=7.
American Red Cross (2001a). Disaster services. Retrieved November
5, 2002, from http://www.redcross.org/services/disaster/beprepared/.
American Red Cross (2001b). Family disaster planning. Retrieved
November 5, 2002, from http://www.redcross.org/services/disaster/beprepared/familyplan.html.
American Red Cross (2001c). Terrorism—preparing for the unexpected.
Retrieved October 22, 2002, from http://www.redcross.org/services/disaster/keepsafe/unexpected.html.
American Red Cross (2002). In the news. Retrieved November 5, 2002,
from http://www.redcross.org/.
American Red
Cross (2004a). Nursing. Retrieved February 9, 2004, from
http://www.redcross.org/services/nursing/0,1082,0_327_,00.html.
American Red Cross (2004b). Disaster Services. Retrieved
February 9, 2004, from http://www.redcross.org/services/disaster/0,1082,0_319_,00.html.
Arizona Department of Health Services (2001). Definition of bioterrorism.
Epidemiology and surveillance. Retrieved November 5, 2002, from
http://www.hs.state.az.us/phs/edc/edrp/es/bthistor1.htm.
CMHS (2003). Self-care tips for emergency and disaster response
workers. Retrieved January 14, 2004, from Substance Abuse and Mental
Health Services Administration, The Center for Mental Health Services,
U.S. Department of Health and Human Services Web site: http://www.mentalhealth.org/publications/allpubs/KEN-01-0098/.
FEMA.gov (2003a).
Are you ready? A guide to citizen preparedness. Retrieved May 6,
2003, from http://www.fema.gov/areyouready/.
Hassmiller, S.B. (2003). Disaster management.
In M. Stanhope, & J. Lancaster, (Eds.), Community health nursing.
St. Louis, MO: Mosby.
hospitalconnect.com (2004). Resources, hospital readiness, response,
and recovery resources. Disaster readiness. Retrieved January 14,
2004, from American Hospital Association Web site: http://www.hospitalconnect.com/aha/key_issues/disaster_readiness/resources/HospitalReady.html.
Joint Commission International
Center for Patient Safety (2007). Emergency Preparedness. Retrieved
April 16, 2007 from http://www.jcipatientsafety.org/14886
Light, C.H. (2003). Statement of Catherine H. Light, Director, Terrorism
Coordination Unit, Office of the Director, Federal Emergency Management
Agency. Retrieved April 29, 2003 from http://www.fas.org/spp/starwars/congress/1997_h/h971104l.htm
MEDLINEplus (2004). Disasters and emergency
preparedness. Retrieved January 14, 2004, from U.S. National Library
of Medicine Wed site: http://www.nlm.nih.gov/medlineplus/disastersandemergencypreparedness.html.
MMWR (2002). Rapid assessment of injuries among survivors of the
terrorist attack on the World Trade Center—New York City, September
2001. Morbidity and Mortality Weekly Report, 51(01), 1-5. Retrieved
November 5, 2002, from Centers for Disease Control Web site: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5101a1.htm.
National Association of School Psychologists (n.d.). Resources.
Retrieved November 5, 2002, from http://www.guidancechannel.com/default.aspx?index=889&cat=13.
National Center for PTSD (2007). Effects of traumatic stress in
a disaster situation. Retrieved January 14, 2004, from, http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_effects_disaster.html?opm=1&rr=rr53&srt=d&echorr=true
National Institute of Mental Health (2001). Helping children and
adolescents cope with violence and disasters. Retrieved November
5, 2002, from National Institutes of Health, Department of Health
and Human Services Web site: http://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-violence-and-disasters-what-parents-can-do.shtml.
NDMS (2003). Retrieved January 15, 2004, from Office of Emergency
Preparedness Web site: http://ndms.dhhs.gov/.
New York State Office of Mental Health (2001). Crisis counseling
guide. Retrieved November 5, 2002, from http://www.crisiscounseling.com/Handouts/WhatIsCrisisCounseling.htm.
Noji, E.K. (Ed.)(1997). The Public Health Consequences of Disasters:
New York, NY: Oxford University Press.
Noji, E.K. (2000). The public health consequences of disasters.
Prehospital Disaster Medicine, 15(4), 147-157. Retrieved November
5, 2002, from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11227602&dopt=Abstract.
Nursing
Spectrum (2003). Public Ranks Nurses #1 for Honesty, Ethics. Retrieved
January 14, 2004, from http://nsweb.nursingspectrum.com/NurseNewsEzine/item.cfm?ID=1330.
Resources for Parents & Teachers (n.d.). Terrorism-related
resources. Retrieved November 5, 2002, from FEMA for Kids Web site:
http://www.fema.gov/kids/teacher.htm#terror.
Songer, T. (1999). Definition of a disaster. Epidemiology of Disasters.
Retrieved September 26, 2002, from http://www.pitt.edu/AFShome/e/p/epi2170/public/html/lecture15/sld007.htm.
United States Department of Health and Human Services (2003). Disasters
and emergencies. Retrieved November 5, 2002, from http://www.hhs.gov/disasters/index.shtml.
U.S. Department
of Homeland Security (DHS), Federal Emergency Management Agency
(FEMA). (2006). Response. Retrieved April 16, 2007 from http://www.fema.gov/government/response.shtm
U.S. Department
of Homeland Security (DHS), Federal Emergency Management Agency
(FEMA). (2006). National Response Plan. Retrieved April 16, 2007
from http://www.dhs.gov/xprepresp/committees/editorial_0566.shtm
University of
Pittsburgh (2003). Center for Biosecurity of the University of Pittsburgh
Medical Center (UPMC). Retrieved January 14, 2004, from, http://www.upmc-biosecurity.org/.
Veneema, T.G.
(ed.) (2003). Disaster Nursing and Emergency Preparedness for Chemical,
Biological, and Radiological Terrorism and Other Hazards: New York,
NY: Springer Publishing Company, Inc.
Test
Questions
Please select
the correct answer for each of the following questions. If you answer
80% or more correctly,
you will be given the opportunity to register for continuing education
credit. After receipt of the registration information and fee, you
may print a continuing education certificate.
Question 1
Of the following disasters,
which is likely to have the fewest injuries or deaths during the
impact period?
Earthquake
Tornado
Slow-rising flood
WMD/T event
Question 2
A large disaster can affect
the public health of a community in which of the following ways?
Disruption of sewage and sanitation systems
Damage to health care infrastructure
Depletion of resources, including medicines
All of the above.
Question 3
Which of these
disasters is least likely to result in activation of the National
Response Plan?
A massive earthquake in California
An apartment complex destroyed by fire in Boston
Record flooding in several Midwest states due to torrential rains
A bomb explosion that spreads radioactive materials in the heart
of Washington, D.C.
Question 4
Under the National
Response Plan, which is the lead agency for the health and medical
response?
Department of Health and Human Services
American Red Cross
American Hospital Association
Environmental Protection Agency
Question 5
Support agencies
to the ESF 8 include which of the following?
Department of Defense, American Red Cross, and Department of State
American Red Cross, Department of State, and Department of Agriculture
Department of State, Department of Agriculture, and Department of
Defense
Department of Agriculture, Department of Defense, and American Red
Cross
Question 6
National Response
Plan ESF #8 has responsibility for which of the following activities?
Mental health care, feeding and sheltering, and veterinary services
Feeding and sheltering, veterinary services, and vector control
Veterinary services, vector control, and mental health care
Vector control, mental health care, and feeding and sheltering
Question 7
Which of the
following would be the most useful to a neighbor with small children
who is asking for disaster preparedness information?
CDC Web site for health professionals
American Red Cross disaster preparedness information
Johns Hopkins bioterrorism Web site
Journal of the American Medical Association (JAMA) bioterrorism
articles
Question 8
According to
the New York State Office of Mental Health, which of the following
individuals would you anticipate to be most vulnerable to disaster-precipitated
stress?
A divorced young female in good health who lives with her parents
A married young male who is diabetic
A widowed elderly female who is diabetic and who lives alone
A married elderly male who is diabetic
For
more continuing education courses, including case studies,
articles and modular courses, visit www.nursingknowledge.org
- Your trusted source for nursing books, CE and more.
|
|