Emergency nurses see everything. Over the last few decades, disasters have claimed millions of lives and cost billions worldwide. According to Goodwin Veenema, there is a disaster requiring international assistance every week on average (2013). Tragedies such as the September 11 World Trade Center attacks, Hurricane Katrina, and the 2010 Haiti earthquake have prompted healthcare providers to rethink their processes for dealing with such events.
Hurricane Katrina, August 2005, New Orleans
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“Photograph by Jocelyn Augustino taken on 08/30/2005 in Louisiana” by Jocelyn Augustino, FEMA / FEMA Photo Library is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License. About this image: New Orleans, Louisiana Aerial views of Hurricane Katrina damage the day after the storm hit.
Nurses must understand their role in emergency preparedness and disaster planning because they frequently have broad leadership responsibilities for community and hospital-level disaster preparedness and response. The definition of a disaster, whether natural or anthropogenic (caused by humans), disaster preparedness and planning, and disaster response, are all covered in this chapter.
Objectives of Learning
Discuss the four major components of emergency and disaster planning: mitigation, preparedness, response, and recovery.
Describe your primary preparedness actions.
Recognize situations that may necessitate more extensive planning.
13.1 Natural disaster
Disasters can be defined in a variety of ways. The World Health Organization (WHO, n.d.) defines a disaster as “a situation or event that overwhelms local capacity, necessitating a request for external assistance at the national or international level.” It is defined as an emergency by the United States Department of Homeland Security (USDHS) as one that “requires responsive action to protect life or property” (USDHS, 2008, p. 138). Hammond, Arbon, Gebbie, and Hutton (2012) summarize these definitions in their statement.
A disaster is “a significant disruption in the functioning of a community or society involving widespread human, material, economic, or environmental losses and impacts that exceed the affected community’s or society’s ability to cope using its resources.” (p. 236)
A disaster is defined as a catastrophic event that overwhelms available resources. Natural or anthropogenic disasters can occur (caused by human activity). In May 2016, a fire in Fort McMurray, Alberta, destroyed 2,400 structures, forcing over 90,000 people to flee the area.
The fire grew so large that it created its weather at one point, necessitating firefighting reinforcements from across the country. All Fort McMurray stores and amenities were closed… and residents were advised to boil their water. Morgan (2016)
Highway 63 near Fort McMurray, Alberta, on May 3, 2016.
Wildfire, disaster, Highway 63, Fort McMurray
“Landscape view of wildfire near Highway 63 in South Fort McMurray,” by , is licensed under a CC BY-SA 4.0 International License and may be used under a CC BY-SA 4.0 International License via Wikimedia Commons.
Tornadoes, earthquakes, floods, and extreme winter conditions occur more frequently than anthropogenic disasters, such as civil unrest, terrorism, and armed conflict; 376 naturally triggered disasters were registered in 2015. (Guha-Sapir, Hoyois, & Below, 2015). Disasters are commonly regarded as “low probability, high impact” events (Saunderson Cohen, 2013, p. 21).
Planning for any disaster necessitates considering common elements such as mitigation, preparedness, response, and recovery. The Emergency Management Act of Canada recognizes the roles that all stakeholders must play in the country’s emergency management system, including “coordinating emergency management activities among government institutions and in collaboration with provinces and other entities” (Emergency Management Act, 2007).
13.2 Disaster Reduction
Disaster mitigation measures eliminate or reduce the effects and risks of hazards by taking proactive steps before an emergency or disaster occurs. It all starts with identifying the risks. Healthcare leaders must assess potential emergencies or disasters that may impact demand for their services and supplies and devise a plan to address those needs. The Red River Floodway is cited as an example of disaster mitigation by Public Safety Canada.
The Floodway was built as a joint provincial/federal project to protect Winnipeg and reduce the impact of flooding in the Red River Basin. In the 1960s, it cost $60 million to build. The Floodway has been used more than 20 times since then. Its use during the 1997 Red River Flood alone is estimated to have saved $6 billion. As part of a joint provincial/federal initiative, the Floodway was expanded in 2006. (2015)
According to Hendrickson and Horowitz (2016), hospital facility planners and health leaders should address the disasters that are most likely to occur in their community and geographic area and conduct a hazard vulnerability analysis to determine the likely vulnerabilities that may arise in their facility as a result of those disasters.
A hazard vulnerability analysis (HVA) is a systematic approach that:
Identifies all potential hazards to a community;
determines the hazard’s likelihood;
determines the hazard’s consequences; and
Analyzes the findings to determine which hazards should be prioritized (Saunderson Cohen, 2013; Hendrickson & Horowitz, 2016).
Industrial sites, for example, that large store quantities of potentially hazardous chemicals pose a hazardous material threat that may necessitate mass decontamination. Area hospitals would require operational decontamination units and an ample supply of ventilators, oxygen, and specific antidotes that are not commonly available in large quantities. Natural disasters frequently increase the number of homeless or displaced people whose daily medical needs may be aggravated by limited access to routine health care. As a result, emergency departments may see more patients seeking medication, treatments, and assessments.
An HVA’s findings can be used to develop and streamline disaster plans. These plans should be developed collaboratively with partners from local police and emergency and fire services. HVAC should be carried out on an annual basis or whenever there are demographic or infrastructure changes that may have an impact on the potential for a disaster.
13.3 Disaster Planning
Figure 13.3.1 Medical Personnel Carrying Out Mass Casualty Scenario Drill
drill, mass casualty drill
“Mercy conducts mass casualty exercise during Pacific Partnership 2015 [Image 12 of 12],” by Mayra Conde, identified by DVIDS, is in the Public Domain and can be found on Wikimedia Commons. About this image: THE SEA OF THE PHILIPPINES (July 16, 2015) During Pacific Partnership 2015, crew members on the hospital ship USNS Mercy (T-AH 19) conducted a mass casualty drill.
Disaster preparedness aims to plan a response that will minimize damage and aid in disaster recovery (Stopford, 2007). Nurses are ideal disaster preparedness leaders due to their expertise in primary health care, extensive experience with interdisciplinary teamwork, and strong collaborative skills. The first step in disaster preparation is to create a strategic emergency management plan (SEMP) (Public Safety Canada, 2016) that anticipates not only disasters that are most likely to occur in a specific geographical area but also those that are unexpected (Saunderson Cohen, 2013).
The SEMP is a broad-scope document that guides and informs partners on responding to disasters internally and externally. It contains specific procedures for:
The plan’s main goals and the method for achieving those goals;
obtaining threat information; and
We are planning the standard response to threats.
13.3.1 Essential Learning Activity
Annex A of Public Safety Canada’s Emergency Management Planning Guide, 2010-2011, contains detailed information on SEMP.
Stopford (2007) provides a detailed list of other processes, which include:
1. Establishing a command and control strategy. When establishing a chain of command, it is critical to have both a command person and a second-in-command in case the primary commander cannot fulfill the role. The command center must also be assigned a specific location in the control plan.
2. Identifying internal and external agencies’ functional roles and responsibilities. During a disaster, internal and external departments must clearly understand their roles and responsibilities, as well as the roles and responsibilities of other parties. Contact information for emergency personnel, as well as their roles, should be easily accessible. Furthermore, essential service personnel should be identified to ensure consistent emergency staff coverage during the disaster.
3. Choosing a communication system. A standard communication process must be developed to address the possibility of system failure. As standard communication equipment, the contingency plan should include landlines, cell phones, and radios.
4. Confirm a legal basis for the response, including infection control isolation strategies as needed. Details for the isolation, infection control processes and the allocation of medications such as vaccines, antibiotics, and antiviral agents should be included in disaster preparedness. Furthermore, legal and ethical concerns must be considered when developing this portion of the plan if facility lockdown and controlled facility access are required.
5. Creating an infectious disease strategy. A standard procedure must address the possibility of an infectious disease outbreak or pandemic. Different illnesses necessitate varying degrees of isolation and personal protective equipment (PPE). Disaster preparedness addresses the possibility of requiring high-level isolation equipment and ensures adequate supplies and equipment are readily available. Emergency care providers should be familiar with the clinical signs of various diseases, and a surveillance methodology plan should be in place to address potential disease progression.
6. Maintaining emergency facilities, equipment, and supplies properly. A standard process for obtaining and maintaining emergency equipment and supplies is required for emergency preparedness. This includes a standard maintenance schedule, a location tracking schedule, and information on where to obtain additional equipment and supplies.
7. Providing emergency disaster preparedness training. Training could include
educating personnel on their roles in an emergency
putting on and taking off PPE;
procedures for decontamination; and
Training should occur regularly and be included in all personnel’s regional orientation. Individual facilities must plan ahead of time for what to do if a disaster disrupts their operations. This planning is aimed at facility leadership and personnel and establishes a standard procedure for ensuring that facilities can continue to provide essential services regularly (Saunderson Cohen, 2013). Stopford (2007) suggests additional considerations include planning for a facility lockdown. Staff may be required to remain in the facility, and if so, they must be trained to develop a family emergency plan.
13.4 Disaster Reaction
The first step in responding to an incident is recognizing the occurrence and implementing the plans developed during the preparedness phase. External responses may include search-and-rescue operations, firefighting, and the construction of shelters for displaced people. To provide the best care for their patients, nurses must have a solid understanding of the disaster plan and a concrete understanding of the events surrounding the incident. During the 2016 Fort McMurray fire, for example, surrounding hospitals were required to be ready to care for many patients with burns and respiratory compromise. This included the general public, firefighters, and other first responders.
Internal facility responses to disasters that are effective include disaster triage and casualty distribution (Saunderson Cohen, 2013). Nursing during a disaster frequently focuses on providing care to an influx of patients to a care center, which necessitates an understanding that these patients may have varying degrees of illness and injury and emotional stress from the event. Disaster triage is defined as “doing the best for the greatest number of casualties” and has been called the “keystone to mass casualty management” (Saunderson Cohen, 2013, p. 26).
Priorities for treatment may differ depending on available supplies and resources and the type of disaster (Stopford, 2007).
Various disaster triage systems have been designed for mass casualty incidents; therefore, facilities must decide which system to use ahead of time. The simple triage and rapid transport (START) tool is one method of disaster triage. This system was created in the 1980s in Orange County, California, and has since spread to many other countries (Saunderson Cohen, 2013, p. 27).
When the triage nurse employs the START tool, patients are quickly assessed (less than one minute) and classified as red, yellow, green, or black.
Figure 13.4.1 Using the START Tool to Assess Patients (Data Source: Table based on material from Saunderson Cohen, 2013.)
Immediate medical attention is required. These patients are in the priority treatment category because they have illnesses or injuries that could result in death or amputation.
Urgent medical attention is required. This patient group requires immediate treatment but can wait until the red-tagged patients are stabilized.
There is very little maintenance required. These patients require treatment but are deemed stable enough to wait several hours.
End-of-life care is necessary. Patients with a black tag are deemed beyond the care team’s ability to provide lifesaving care. They are either about to die or are already dead.
13.4.1 Essential Learning Activity
The JumpSTART system is used in mass casualty incidents involving many pediatric patients. Learn about triaging pediatric patients using the US Department of Health and Human Services JumpSTART Pediatric Triage Algorithm.
13.5 Recovery from Disaster
Figure 13.5.1: Thanks to Nurses
Thank you, nurses
Saskatchewan Registered Nurses Association’s “Assiniboia flag raising flag signing” is licensed under a CC BY Attribution 4.0 International License.
Following the response phase, disaster recovery is defined by the short-term and long-term actions required to return the community to normalcy. Short-term recovery includes the restoration of critical life support systems and the repatriation of patients. Creating a protocol for patient’s safe return to their designated facility as soon as possible helps reduce the psychological trauma of family separation. It also lessens the strain on the alternate care facilities, and personnel called into action during the disaster (Assid, 2014).
Long-term recovery actions include restoring damaged infrastructure and property and providing physical and psychological support to victims, families, and responders (Upton, 2013). Physical damage is a visible sign of a disaster but is not always present (Saunderson Cohen, 2013). Pandemics, bioterrorism, and cyberterrorism are disasters that leave little or no visible trace. However, the psychological impact on patients and the healthcare team may last for years. Individuals who witness a traumatic event are at risk of long-term consequences, which can be physical, emotional, spiritual, or mental. These responses have the following characteristics:
emotional responses to events
loss of functional ability;
feeling overburdened; and
Increased use of resources.
1 reference within 5 years
The definition of Mentoring can be comprehensive. Its concept is used in the nursing profession and other professions in the medical field as a professional and personal development connection. Mentoring is a long-term partnership. They are based on trust and knowledge. Many nursing faculty members are retiring. Thus replacements are needed, and the opportunity to engage with needed members is to the mentoring route.
There are multiple benefits for the mentor and the mentee during the successful mentoring process. In this long life or short time relationship need to be a commitment to help each other during the length of the mentoring process time. (Nell Ard, et al ., 2022)
This article mentioned four stages of mentoring: initiation, nurturing, separation, and redefinition. A solid mentoring team must be established in every department to improve the retention rate of nursing staff. Suppose a nursing education unit has never had a formal mentorship program for incoming staff or is having trouble retaining faculty. In that case, it is an unstable platform for novice nurses to dive into. When faculty members identify talents or areas needing enrichment, they can seek more mentoring or consider mentoring fresher teachers.
Nursing faculty shortage threatens. Aging professors and recruitment and retention challenges contribute to this crisis. this journal article focuses more on mentoring requirements, Time, and faculty support aiming for mentorship. The ideal supports nurse mentorship as creating a loving mentorship atmosphere can be a way to preserve nursing education’s integrity( Jo-Ann V. et al., 2009)
This other article discusses an example of mentoring using the mentorship technique to help new teachers develop NCLEX®-style questions. this mentor relationship approach helps beginner and experienced nursing faculty collaborate through training, assessment, rewriting, and mentoring. The mentor works with the more experienced educator during training, evaluation, and rewrite phases and reviews the final test. (Sarah S et al., 2021)
Visionary knowledge educators are vital in establishing ongoing mentoring processes within healthcare settings. (Nelda E.et al., 2021) The win/win mindset in the mentoring relationship needs to be implemented right at the Time of the hiring process for all new employees so this mentality stays during the establishment’s life. (Nelda E.et al., 2021)
Jo-Ann V. Sawatzky, Carol L. Enns, A Mentoring Needs Assessment: Validating Mentorship in Nursing Education,Journal of Professional Nursing, Volume 25, Issue 3, 2009,Pages 145-150, ISSN 8755-7223, https://doi.org/10.1016/j.profnurs.2009.01.003.
Nell Ard, Sharon F. BeasleyMentoring: A key element in succession planning, Teaching and Learning in Nursing, Volume 17, Issue 2, 2022,Pages 159-162, ISSN 1557-3087, https://doi.org/10.1016/j.teln.2022.01.003.
Nelda Ephraim, Mentoring in nursing education: An essential element in the retention of new nurse faculty, Journal of Professional Nursing, Volume 37, Issue 2, 2021, Pages 306-319, ISSN 87557223, https://doi.org/10.1016/j.profnurs.2020.12.001.
Sarah Smith, Melissa Geist,TERM model: The incorporation of mentorship as a test-item improvement strategy,Teaching and Learning in Nursing,Volume 16, Issue 1,2021,Pages 60-62, https://doi.org/10.1016/j.teln.2020.05.008.