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Community Emergency Preparedness

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Disasters, whether natural or man-made can strike a community at any given time without notice. Year after year, hurricanes, earthquakes, oil spills, and other disasters make news headlines. As recent history has shown, it is critical that businesses, individuals, and organizations are prepared to respond during and after a disaster situation. Situations such as those that occurred during Hurricane Katrina, serve to highlight the need for citizens and businesses to coordinate their efforts to work toward protecting lives and property prior to an emergency situation. The scenario presented in the Pearson Health Science online community demonstrates a community with a poor emergency management plan. The Neighborhood is a riverfront community bordered by the Neighborhood River and the Neighborhood Forest. There are approximately 64, 200 residents living in the Neighborhood. The residents have access to several health care facilities, including an acute care hospital with an outpatient surgery center, and two urgent care centers; a rehabilitation hospital; and the community health department that includes an immunization clinic, a family planning clinic, and homeless health care services.

There are also various outpatient health care services, such as physician offices, optometrists, dentists, etc., along with several nursing homes and assisted living facilities. The Neighborhood News reports firefighters are battling an out-of-control wildfire in the nearby forest. The fire has been burning uncontrolled for five days and has left numerous acres of land charred. City officials have notified town residents that there is no immediate danger, and that officials will keep the town informed of any changes. As the fire rages on, air quality continues to deteriorate and residents with pre-existing lung disease are the most affected. Residents, especially those with cardiac and respiratory conditions, have been advised by public health officials to remain indoors unless absolutely necessary because of the poor air quality. Nurses working in Neighborhood facilities begin to noticing an increase in number of patients requiring respiratory assistance as the fire rages on.

The Neighborhood hospital is functioning at capacity, as an influx of patients are admitted through the ER with exacerbation of respiratory symptoms caused by smoke from the forest fire. Units are full and there are not enough available beds to accommodate the number of patients requiring hospitalization. Working non-stop to in an attempt to keep the patient flow moving smoothly, the constant demand for quick patient changeover has the staff suffering from stress and low morale. Clients visiting the Neighborhood senior center have also been exhibiting symptoms of excessive exposure to the smoke from the forest fire. Nurse Karen has made note that clients with pre-existing respiratory conditions requiring oxygen have needed to use it more often this week. Nurse Karen makes it a priority to educate her clients about reducing exposure to the irritants in the air and advises them to stay inside to protect themselves from further harm.

Students at Neighborhood Elementary School are also feeling the effects of the irritants in the air due to the nearby fire. Kelsey Young, a second grade student is sent to the school nurses office by her teacher due to excess coughing. Nurse Violet noted an increased respiratory rate, frequent coughing, and wheezing. The student, Kelsey is suffering an exacerbation of asthma symptoms. Unfortunately, the student does not have an inhaler available for use at school so Nurse Violet placed a telephone call to the parent requesting the student be picked up and taken to the physician for evaluation. Nurse Violet encourages the parent to provide the school with an inhaler that can be left in the nurses office for Kelseys use if necessary; however, Mrs. Young seems hesitant. Although unable to convince Mrs. Young to send an inhaler for use at school, Nurse Violet is successful at convincing her to take Kelsy for needed medical assessment and treatment. Jimmy and Cecelia Bley are a Native American couple that live in the Neighborhood. Both in their 70s, each suffers the consequences of several health issues.

Jimmy is most affected by the poor air quality caused by the fire burning in the nearby forest as he has a history of emphysema. Although he has learned to pace himself to complete most his activities, Jimmy heeds the advice of officials and decides to wait to go buy a part needed to fix their broken dryer. Jimmy also has issues with hearing loss that he does not acknowledge as a big problem; however, Jimmys hearing loss appears to cause quite a bit of stress in his relationship with his wife as the two argue often due to communication issues. Cecelia has very few health problems, although she does suffer from osteoarthritis. She takes medications to manage the pain, and has learned to modify her activity as needed to reduce stress on already painful joints. Cecelia and Jimmy have raised a large family, all of which remain in the local area. One of their daughters came over to take Cecelia to the Laundromat to finish her laundry, unfortunately with the women gone Jimmy is left at home alone.

Deficiencies in the town disaster plan appear apparent as the fire continues to burn and medical resources are quickly consumed, leaving medical professionals scrambling to provide care for an overwhelming number of patients. Several agencies on local, state, and federal levels are available to provide assistance in disaster situations. Local agencies that could help in a disaster situation include local emergency medical services, hospitals, county public health departments, visiting nurses, community emergency response team (CERT), and the local chapter of the American Red Cross. Each of these institutions or agencies can provide services, personnel, and supplies needed to manage disaster or emergency situations. Community emergency response teams are specially trained teams of community members who assist during the periods when professional responders are not available. They received training in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations (Citizen Corps, n.d.) .

Utilizing services of public health practitioners, such as visiting nurses or other medically trained volunteers would have been beneficial in assessing the needs of community residents. A visiting nurse could have assessed Jimmys respiratory condition along with addressing the familys basic needs for food, laundry, and especially safety. Jimmy staying alone in the home while his wife and daughter went to the Laundromat was unsafe, not only because of his respiratory condition but also his hearing loss. His denial of his hearing loss made it unlikely Jimmy wore hearing aids, therefore the possibility of missing the announcement of an impending evacuation was increased.

Several state and federal agencies exist to assist the nations communities during times of disaster. The State Office of Emergency Management and Federal Emergency Management Agency (FEMA) are two agencies that have several resources available to assist residents, organizations, and medical systems prepare for and respond to situations, which might overwhelm local resources. The New Jersey State Office of Emergency Management website contains a registry for residents with special needs so that emergency responders can easily identify, locate, and coordinate plans to serve them in a disaster or other emergency (State of New Jersey, 2008). Registration with such an agency would have made it possible for officials to have advance information regarding Jimmy Bley’s medical conditions, needs for assistance and location in the event of an evacuation.

A federal agency responsible for coordinating responses to disasters that overwhelm state and local resources is FEMA. Operating under the auspices of FEMA, exists the National Disaster Medical System (NDMS) that can be activated should the medical system in the local area of a disaster become overwhelmed and require diversion of patients to another area for treatment (Force Health Protection and Readiness Policy, 2010). Activating this system would have been beneficial for the Neighborhood hospital as not only could the NDMS provide additional personnel if necessary but also assist in transferring patients to nearby hospitals as the unit became overwhelmed with patients from the fire, and it became apparent that the hospital was unprepared to care for the number of patients requiring admission.

In a disaster or emergency situation, the services of nurses will be greatly needed, whether on a professional or volunteer level. Stanhope and Lancaster (2010) suggest that nurses without proper personal emergency management plans in place will be unable to fully participate in disaster relief efforts as their concerns about family, friends, or other personal obligations distract their attention. It is important that along with assisting educating and assisting others to prepare for emergencies, nurses develop their own plans customized to the needs of their lives and families. Families should have disaster kits for the home and each car. Nurses should also have a nursing specific disaster kit in an easily accessible location. Disaster plans should be developed and discussed with other family member, confirming that each member understands what is expected. To prevent panic in an emergency situation, prior preparation in the form of fire or evacuation drills should be practiced to ensure each member knows how to exit the building.

Also every capable member should know how to shut off the utilities, use a fire extinguisher, and practice first aid. Nurses should know their local areas disaster plan, and if possible obtain volunteer training through American Red Cross or Community Emergency Response Teams. Untrained professionals arriving at disaster scenes to volunteer create added burden for first responders as they arrive unprepared and place themselves and others in danger (Stanhope & Lancaster, 2010). Disaster preparation is “a continuous cycle of planning, organizing, training, equipping, exercising, evaluating, and taking corrective action in an effort to ensure effective coordination during incident response” (Federal Emergency Management Agency, 2012 para 4). Individuals, businesses, and organizations must band together to provide for the community in times of disaster. Preparation is an important step in protecting lives and minimizing the negative consequences.

Citizen Corps. (n.d.). Community Emergency Response Teams (CERT). Retrieved from http://citizencorps.gov/cert Federal Emergency Management Agency. (2012, January 19). Plan and Prepare. Retrieved from http://www.fema.gov/plan/index.shtm Force Health Protection and Readiness Policy. (2010, April). National disaster medical system: Patient Movement. Retrieved from http://ndms.fhpr.osd.mil Stanhope, RN,DSN, FAAN, M., & Lancaster, RN, PhD, FAAN, J. (2010). Public health nursing: Population-center health care in the community (8th ed.). Maryland Heights, MO: Mosby. State of New Jersey. (2008). New Jersey Special Needs Registry for Disasters. Retrieved from http://www13.state.nj.us/specialneeds

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