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Nurses perform a variety of roles and their responsibilities as health care providers extend to the community. The decisions we make daily and in times of crisis often involve the balancing of human rights with medical necessities, equitable access to services, legal and ethical mandates, and financial constraints.
In the event of a major accident or natural disaster, many issues can complicate decisions concerning the needs of an individual or group, including understanding and upholding rights and desires, mediating conflict, and applying established ethical and legal standards of nursing care. As a nurse, you must be knowledgeable about disaster preparedness and recovery to safeguard those in your care. As an advocate, you are also accountable for promoting equitable services and quality care for the diverse community.
Nurses work alongside first responders, other professionals, volunteers, and the health department to safeguard the community. Some concerns during a disaster and recovery period include the possibility of death and infectious disease due to debris and/or contamination of the water, air, food supply, or environment. Various degrees of injury may also occur during disasters, terrorism, and violent conflicts.
To maximize survival, first responders must use a triage system to assign victims according to the severity of their condition/prognosis in order to allocate equitable resources and provide treatment. During infectious disease outbreaks, triage does not take the place of routine clinical triage.
Trace-mapping becomes an important step to interrupting the spread of all infectious diseases to prevent or curtail morbidity and mortality in the community. A vital step in trace-mapping is the identification of the infectious individual or group and isolating or quarantining them. During the trace-mapping process, these individuals are interviewed to identify those who have had close contact with them. Contacts are notified of their potential exposure, testing referrals become paramount, and individuals are connected with appropriate services they might need during the self-quarantine period (CDC, 2020).
An example of such disaster is the COVID-19 pandemic of 2020. People who had contact with someone who were in contact with the COVID-19 virus were encouraged to stay home and maintain social distance (at least 6 feet) from others until 14 days after their last exposure to a person with COVID-19. Contacts were required to monitor themselves by checking their temperature twice daily and watching for symptoms of COVID-19 (CDC, 2020).
Local, state, and health department guidelines were essential in establishing the recovery phase. Triage Standard Operating Procedure (SOP) in the case of COVID-19 focused on inpatient and outpatient health care facilities that would be receiving, or preparing to receive, suspected, or confirmed COVID- 19 victims. Controlling droplet transmission through hand washing, social distancing, self-quarantine, PPE, installing barriers, education, and standardized triage algorithm/questionnaires became essential to the triage system (CDC, 2020; WHO, 2020).
This assessment provides an opportunity for you to apply the concepts of emergency preparedness, public health assessment, triage, management, and surveillance after a disaster. You will also focus on evacuation, extended displacement periods, and contact tracing based on the disaster scenario provided.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
When disaster strikes, community members must be protected. A comprehensive recovery plan, guided by the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework, is essential to help ensure everyone’s safety. The unique needs of residents must be assessed to lessen health disparities and improve access to equitable services after a disaster.
Recovery efforts depend on the appropriateness of the plan, the extent to which key stakeholders have been prepared, the quality of the trace-mapping, and the allocation of available resources. In a time of cost containment, when personnel and resources may be limited, the needs of residents must be weighed carefully against available resources.
In this assessment, you are a community task force member responsible for developing a disaster recovery plan for the Vila Health community using MAP-IT and trace-mapping, which you will present to city officials and the disaster relief team.
To prepare for the assessment, complete the Vila Health: Disaster Recovery Scenario simulation.
In addition, you are encouraged to complete the Disaster Preparedness and Management activity. The information gained from completing this activity will help you succeed with the assessment as you think through key issues in disaster preparedness and management in the community or workplace. Completing activities is also a way to demonstrate engagement.
Begin thinking about:
You may also wish to:
Every 10 years, The U.S. Department of Health and Human Services and the Office of Disease Prevention and Health Promotion release information on health indicators, public health issues, and current trends. At the end of 2020, Healthy People 2030 was released to provide information for the next 10 years.
Healthy People 2030 provides the most updated content when it comes to prioritizing public health issues; however, there are historical contents that offer a better understanding of some topics. Disaster preparedness is addressed in Healthy People 2030, but a more robust understanding of MAP-IT, triage, and recovery efforts is found in Healthy People 2020. For this reason, you will find references to both Healthy People 2020 and Healthy People 2030 in this course.
Complete the following:
Describe the plan for contact tracing during the disaster and recovery phase.
The requirements outlined below correspond to the grading criteria in the scoring guide, so be sure to address each point:
MUST INCLUDE !!!!!
Name (Presenter) Institution Affiliated
after an emergency or disastrous event.
Objectives
collaboration
target of the plan
? Health services-Reduced access to health services after a
disaster
? Physical environment
The Needs of the Vila Health Community
? The purpose of the disaster strategy plan for Villa Health Community is to lessen health disparities and improve access to services after a disaster
? Derived needs from the main the purpose of the disaster strategy plan include
? Favorable public policies
? Improved public services
? Health services
? Education
? Transport and communication
Tools To Implement the Disaster Recovery Plan
? MAP-IT (Mobilize, Assess, Plan, Implement, Track) is a tool for planning and evaluating public health interventions
? It involves all stakeholders
? Assessment means that the effort will start
from the reality of the community
Change of Command
? The basic ingredient of any recovery plan
? Involvement of different agencies in addition to the community emergency response
? Determining the leading agencies in the
recovery process
Disaster Recovery Members and Recovery Timeline
Disaster Recovery Members
? Selection of executive and team members
? Introduction of the parties to the region (McGinnis, 2021)
? Allocations of various roles to different members
? Stipulation of the extend of recovery plan implementation
? Keep track of timing of major activities to be implemented during different phases of recovery (McGinnis, 2021)
? Cultural barriers-Rigidity in beliefs (religion) and language
differences
? Economic barriers
? Financial constraints
? Social barriers
? Poor collaboration between the disaster management team
? Ineffective communication among the disaster management team
? Lack of an integrated disaster management system
? The purpose of the proposed disaster recovery plan is to reduce health
disparities and improve access to services through
? Focusing on the most disadvantaged groups (Stafford & Wood, 2017)
? Narrowing Health gaps
? Reducing the social gradient
? Recovery plan inclusive of all patients irrespective of their demographics (reduces disparity) (Stafford & Wood, 2017)
? Infrastructure improvement-improve access to services (Yu et al., 2017)
? The DR plan ensures that the critical areas necessary for return to normalcy
are handled (CDC, 2020).
? Equity, as a principle of social justice is applied in healthcare
? Care is given based on the need
? Cultural sensitivity-Enables delivery of culturally competent care
? Ability to acknowledge cultural norms of patients-skill of a care
provider
? Enables provision of a nonbiased care to a diverse group (CDC,
2020)
? Fairness in provision of care irrespective of the differences-
equity
? Federal Emergency Management Agency [FEMA] (2017) outlines
the policies
? Example-Presidential Policy Directive 8-whole community
involvement
? Disaster Recovery Reform Act of 2018 -prepares a nation for a future
disaster
? Impact on recovery efforts are as follows
? Encourages collaboration among community-shared responsibility
? Policies support creation of a national preparedness goal
? Identification of loopholes to be addressed
? Non-functional communication that may result during a disaster
includes
? Problem coordinating radio communication
? No contact with first responders the first few hours
? Language boards
? Kwik point Medical Translator
? Mobile apps to inform the emergency center (Abbas & Norris, 2018)
? Activate emergency alarms
? Use of social media to reach a massive population (Abbas & Norris, 2018)
? Various professions displayed by the case
? Health care workers, administrators, financial officers
? EMTs, police, fire department team
? Disorganization during the catastrophe reveals a poor IPC
? Delegation of duties help (Digregorio et al., 2019)
? Implementation of IPC education in schools
? Proper disaster plan-specify role of each participant
? Economic status, physical environment and policies determine
their health
? Cultural, economic and social factors can be barriers to disaster
recovery efforts
? Proposed plan-reduce health disparity; improve health access
? Governmental or state policies significantly affect health
? Language boards, cell phones, social media enhance communication
? Delegation, IPC education, proper disaster plan enhance IPC
? Abbas, R., & Norris, T. (2018). Inter-Agency Communication and Information Exchange in Disaster Healthcare. ISCRAM, 2- 7.
? Centers for Disease Control and Prevention. (2020). Emergency Preparedness and Response. Retrieved from CDC: https://emergency.cdc.gov/
? Department of Economic and Social Affairs. (2019). Population and Vital Statistics Report: Statistical Papers Series A Vol.
LXXI. New York: United Nations.
? Digregorio, H., Graber, J. S., Saylor, J., & Ness, M. (2019). Assessment of inter-professional collaboration before and after a
simulated disaster drill experience. Nurse education today (79, 194-197.
? Federal Emergency Management Agency (FEMA). (2017). Pre-Disaster Recovery Planning Guide for Local Governments.
FEMA Publication FD 008-03, 5-10.
? Healthy People. (2020). Determinants of Health. Retrieved from U.S Department of Health and Human Services: https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health
? McGinnis, J. M. (2021). Healthy people 2030: A compass in the storm. Journal of Public Health Management and Practice:
JPHMP, Publish Ahead of Print(6), S213–S214. https://doi.org/10.1097/phh.0000000000001328
? Stafford, A., & Wood, L. (2017). Tackling health disparities for people who are homeless? Start with social determinants.
International Journal of Environmental Research and Public Health, 14(12), 1535. https://doi.org/10.3390/ijerph14121535
? Yu, S. W. Y., Hill, C., Ricks, M. L., Bennet, J., & Oriol, N. E. (2017). The scope and impact of mobile health clinics in the United States: a literature review. International Journal for Equity in Health, 16(1), 178. https://doi.org/10.1186/s12939-017- 0671-2
For a health care facility to be able to fill its role in the community, it must actively plan not only for normal operation, but also for worst-case scenarios which could occur. In such disasters, the hospital’s services will be particularly crucial, even if the specifics of the disaster make it more difficult for the facility to stay open.
In this scenario, you will resume your role as the senior nurse at Valley City Regional Hospital. Like many facilities within the Vila Health network, Valley City Regional serves as the primary source of health care for a wide area of North Dakota. As such, it is even more imperative than usual that it stay open and operational in all situations. Doing this means planning and preparation.
The administrator of the hospital, Jennifer Paulson, wants to talk to you about disaster preparedness and recovery at Valley City Regional. But first, you should read some background information about events in Valley City in the past few years, including the involvement of the hospital.
Op-ed by Anne Levy, Valley City Herald
Valley City has had a great year, growing on a number of fronts. But all of our growth and success exists in the shadow of the recent past, a case of recent wounds slowly healing and fading to scars.
No one who was in Valley City two years ago will ever forget the catastrophic derailment of an oil-tanker train and the subsequent explosion and fire. While fatalities were fewer than they could have been, six residents of our city lost their lives. Nearly two hundred were hospitalized, and much of the city was temporarily evacuated. Several homes near the railroad tracks were leveled, and our water supply was contaminated by oil leakage for several months.
Life has resumed, and we have begun to thrive again, in our fashion. But the nagging feeling recurs: When the disaster struck, were our institutions properly prepared? No one wakes up in the morning expecting a train derailment, of course. But responsible institutions think about things that could go wrong within the realm of possibility, and make a plan. Many individuals performed brave, inspired, selfless service in the chaos of the derailment, but it is clear in retrospect that much of the work was improvised, disorganized, and often circular or at cross-purposes.
For the first two hours of the crisis, the Valley City Fire Department was caught unprepared by the damage to the city water supply caused by the explosion, which was more extensive than had been considered possible. The Fire and Police departments had trouble coordinating radio communications, and a clear chain of command at the scene between departments was painfully slow to emerge. The hospital was woefully understaffed for the first six hours of the crisis, taking far too long to find a way to bring additional staff and resources onto the scene. The city health department was unacceptably dilatory in testing the municipal water supply for contaminants.
A call from the Herald’s offices to City Hall confirmed that the city’s disaster plan is over a decade old, and is unfortunately myopic both in the events it considers as possible disasters and in the agencies it plans for. It is of utmost importance to the future of our city that this plan be revised, revisited, and expanded. All city agencies should review their own disaster plans and coordinate with the city for a master plan. The same goes for crucial non-government agencies, most especially the Valley City Regional Hospital. Of course, this all exists in the shadow of budget cuts both at city hall and the hospital.
The sun is shining today, without a cloud in the sky. This is the time to make sure we are ready for the next storm, so to speak, to hit our city. No one knows what the next crisis will be or when it will come. But we can count on the fact that no one will get up that morning expecting it.
FACT SHEET:
Population: 8,295 (up from 6,585 in 2010 census)
Median Age: 43.6 years. 17.1% under age 18; 14.8% between 18 and 24; 21.1% between 25 and 44; 24.9% 46 – 64; 22% 65 or older.
Officially, residents are 93% white, 3% Latino, 2% African-American, 1% Native American, 1% other.
—additionally, unknown number of undocumented migrant workers with limited English proficiency
Special needs: 204 residents are elderly with complex health conditions; 147 physically disabled and/or use lip-reading or American Sign Language to communicate.
Note that the Valley City Homeless shelter runs at capacity and is generally unable to accommodate all of the city’s homeless population. Also, the city is in the midst of a financial crisis, with bankruptcy looming, and has instituted layoffs at the police and fire departments.
105-bed hospital (currently 97 patients; 5 on ventilators, 2 in hospice care.)
NOTEWORTHY: Both of VCRH’s ambulances are aging and in need of overhaul. Also, much of the hospital’s basic infrastructure and equipment is old and showing wear. The hospital has run at persistent deficits and has been unable to upgrade; may be looking at downsizing nursing staff.
Jennifer Paulson
Administrator, Valley City Hospital
Hello, thanks for stopping by. I hope you’re settling in well.
I’d been planning on talking to you about disaster planning in the near future anyway, but now it looks like it’s a lot more urgent. I’m not sure if you’ve heard, but the National Weather Service says we’re going to be at an elevated risk for severe tornadoes in Valley City this season. I’m taking that as a clear sign that it’s time we get serious about disaster planning.
And it’s not just me… The mayor just called me and asked the hospital to check our preparedness for a mass-casualty event, given recent qualms about the way the derailment was handled. For instance, did you see that op-ed in the paper about disaster planning?
Anyway. My particular concern is patient triage in the near term and recovery efforts over the next six months. As I work on a more formal response to the Mayor about where we’re at for this threat, I’d appreciate it if you could do some research and planning on this matter. Even if we dodge the bullet on these tornadoes, there’ll be something else in the future. We need to stop putting it off and get serious about our disaster planning.
What I’d like for you to do first is take some time to talk to a good cross-section of people here at the hospital about what happened last time, and about our disaster plan in general. Make sure you get people from administration as well as frontline care staff; after all, problems can be visible in one area but not another a lot of times.
So spread it around! Since you weren’t here for the train crisis, I think you’re in a unique position to have a fresh, unbiased outlook on it. Actually, first you might find it useful to take a look at the hospital fact sheet, just to brush up on our basics here.
After you’ve looked at the fact sheet and done some talking to people, I’d like you to swing back by and we’ll talk about next steps.
Thanks!
Kate McVeigh
RN
Hey there! Yeah, I think I have a minute or two to talk about the derailment. Wow. It’s crazy. I guess that’s been a while, but it still feels like it just happened. It’s all so vivid!
I was on shift when it happened, so I was here for the whole thing. The blast, the first few injuries, and then the wave. I think I was working for 16 hours before Heather, the former head nurse, told me to leave before I passed out.
I just remember a big jumble. We had waves of people coming in before we were really aware of what we were up against. Someone actually brought out the disaster plan but it was kind of useless. Just a bunch of words abou
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