For this to happen, the nurse, particularly the nurse manager, must be able to incorporate emergency codes, disaster plans, fire safety plans, and evacuation procedures into their individual program. Emergency management documentation for the organization, particularly the cardiopulmonary and advanced cardiac life support systems, and the ER Triage Unit so that the healthcare facility can be more prepared for the emergency.
Disaster in Franklin County
Emergency Management is the organizational protocol that prepares for disaster response, supporting and rebuilding systems and society after natural of human disasters occur, and a continuous process in which groups from the community level up manage potential hazards and the impact of any possible trauma. EM is visible when events occur (hurricanes, flooding, bombs, etc.) but is really only as powerful and effect as its pre-Crisis planning and risk reduction management allows (Haddow, 2004, 2-4). Nursing response to emergencies will then, take two forms; the emergency room nurse manager who deals with tactical emergencies on a regular basis and the strategic nurse manager who prepares for uncommon and rare emergencies, and interfaces with the appropriate levels of community disaster preparedness groups. The manner in which nurses can interface well with emergency management comes partly through knowledge and participation in policy development -- working with their own administrator to regularly attend Emergency Management Team meetings, act as a liaison with that particular healthcare unit, participate in medical education programs, and train for both the strategic and tactical forms of program implementation at the local and regional levels. This is particularly important for the modern nurse since, after 9/11, hospitals realize that staff can be at the forefront of disaster mitigation (Veenema, ed., 2007, pp. 42-3).
Role of Public Health Personnel
The major roles within a disaster are complex and interrelated, depending on the type and severity of the disaster. Essentially, the focus of all personnel is the safety and well-being of the community, both life and property. The Public Health Nurse is one of the members of this team and acts in a complimentary or solo role, again, depending on the situation. The issues vary, but almost always involve problems with immediate medical attention, trapped individuals, food and water availability and safety issues, and septic systems. Additionally, shelters may need to be constructed and communication services established. In the scenario, it was quite beneficial that the Emergency Operations Center Incident Commander (EOC) requested the public health staff early in the situation, and that most had National Incident Management Training.
Chain of Command
During a disaster, particularly if there are issues in communications, it is important to form a specific hierarchy so that needed issues can be handled. In the scenario public health personnel were assigned to Operations, Logistics, Planning and Liaison, Information and Finance/Admin -- quite similar to EOC chain of command but allowing each to take responsibility for the performance of duties, status updates, and requests for additional services. The community health nurse was part of the Public Health group, which is part of the Medical Branch reporting to the Operations Sections Chief. The public health nurse worked on a tactical, door-to-door team made up of public health, public works, and fire department personnel to assess the issue of power outage, road damage, and health. The nurse was also able to treat minor injuries and assess individual situations.
Resources
The benefit of synergistic resources is that while the public health nurse had duties that may have been slightly out of her scope, she had team members to help. For instance, water supply issues had a direct line to a Liaison Officer to contact water vendors and execute tactics. The command center also supplied resources to help with shelter, bedding, food, clothing and emergency medical issues. The nurse then had a physical location to set up a triage event and create a care plan. We can visualize the necessary resources for the nurse as the nurse being the hub of the wheel and each spoke a specific alternating resource, all situationally dependent. For instance, if the nurse finds a distressed patient having a cardiac incident, a call to logistics is made and a helicopter dispatched to ferry the patient to the closest ER. If there has been a toxic spill in a home or business, the nurse uses the resources from the Environmental Quality department to clean or contain the issue while treating patients or evacuating them.
Actions During Interviews
In the scenario, the actions of the nurse during interviews varied. It was, however, more focused on quickly assessing the situation for severity of injury, patients at risk, or needed supplies for marginalized populations (children, geriatric patients, or patients with special needs. The nurse in the scenario had to deal with interpretive issues (language), social and behavioral situations (e.g. people are under great stress and may not be acting rationally, and most of all, finding a solution that met the needs of the individuals in duress. The nurse in the simulation also did an excellent job in educating individuals so that they can take some responsibility for their own health and care. This follows the medical paradigm of nursing's responsibilities and responses to emergency situation. Most scholarship in nursing sees the nurse's role as one of leadership; the physicians are tasked with triage and emergency care management, but the nurse needs to advocate for communities, vulnerable populations, and have the competencies to proactively assist in emergency management situations (health promotion, risk reduction, disease prevention and illness and disease management). To do this, however, nurses need to both define their role and function within the emergency management paradigm and prepare ahead for intervention.
Post-Disaster Actions
This scenario outlined the importance that nurses should actively participate in emergency management drills and practices as much as time, and policy allow, but at least annually. Within the emergency management community, there are of course, several local, state, regional and national agencies. Two of these agencies, FEMA, noted above, and the Nursing Emergency Preparedness Education Coalition (NEPEC), formed a protocol in conjunction with Vanderbilt University that coordinates emergency preparedness with nursing organizations. The goals of NEPEC are in direct relation to the nurse participating in emergency management practices but incorporating the more global recommendations into local programs. There are four major goals: 1) increase the awareness and knowledge to all nurses about mass casualty incidents; 2) provide guidance and research to individual nursing and hospital programs that will help train for mass casualty events; 3) monitor and advocate for legislation that is support of such efforts; and 4) increase the effectiveness of all nurses responding to mass casualty incidents by instituting regular and robust training programs that nurses can easily incorporate into their own schedules, but have macro and micro meaning for their overall emergency preparedness (Veenema).
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