Emergency

Preparedness and
Response for Today’s
World
BY: MARIA JENNIFER DOMINGO
Emergency Preparedness and
Response for Today’s World
1) The Basics of Emergency Preparedness and Response
2) Stages of Disaster
2.1. Preparedness Phase
2.2. Relief Response
2.3. Recovery
3) Communication Within the Health Care Facility
4) Biologic Causes of Mass Casualty: Pandemic Influenza
The Basics of Emergency
Preparedness and Response
•Activities that build capability and capacity to address potential needs identified by the threat of
a disaster and the actions taken to address the immediate and short-term effects of the disaster.
•A disaster condition is defined as a significant natural disaster or man-made event that
overwhelms the affected state and necessitates both federal public health and medical care
assistance.
•In some situations, the number of victims is so large that multiple organizations will be called to
respond. When casualties occur at this level, the event is termed a mass casualty incident (MCI)
or mass casualty event (MCE).
•It is important for nurses to understand the stages of a disaster to be able to determine the
actions that are needed during each phase.
The Basics of Emergency
Preparedness and Response
•Triage: there is a shift to change priorities into doing the greatest good for the greatest number
of people. Care is given to those patients who have the greatest chance of survival.
•Resources: nurses may find themselves in positions where there is a lack of necessary resources,
and they will then have to come up with creative solutions.
Ex: Australian team in the Maldives post-tsunami 2004 used rigid plastic drink bottles as sharps
containers at each patient’s bed area and used the large, rigid containers used to transport
medical supplies as privacy screens and walls between treatment areas.
The Basics of Emergency
Preparedness and Response
•Terrorism has also created the need to prepare against a variety of different agents.
• A standardized nomenclature has been developed for five categories using the acronym CBRNE,
which stands for chemical, biologic, radiologic, nuclear, and explosive.
Stages of Disaster
Powers (2010) describes three phases of the disaster continuum: (1)preparedness, (2)relief
response, and (3)recovery.
1. Preparedness – in this phase, activities are focused on planning, preparedness, prevention,
and warning.
2. Relief Response – in this phase, after the impact, all efforts are directed to responding to the
disaster, initiating the emergency management system, and mitigating the effects of the
hazard.
3. Recovery – during the recovery phase, which usually begins 72 hours after the disaster and
may continue for 2 to 3 years, a network of activities is designed to enhance rehabilitation
and reconstruction. Evaluation of the disaster preparedness and response plan is a major
activity that needs to be included in the recovery phase.
Preparedness Phase
•Communities plan for the services that will be needed in a time of disaster and train the
providers within each agency about responding to all-hazard types of MCEs (mass casualty
events).
•The key elements of a community preparedness program should include the following:
1) Assessing the community for risks and determining the types of events that may occur.
2) Planning the emergency activities to ensure a coordinated response effort.
3) Building the capabilities that are necessary to respond to the consequences of the events.
•Efforts must be directed toward the interrelationship of roles and responsibilities of the agencies
and services that will be needed a the time of disaster (Fig.15-1)
Preparedness Phase
•There must be agreements between agencies within the community and between neighboring
communities for such entities as emergency response units, hospitals, long-term care facilities,
clinics, and health departments to be able to provide mutual aid and transfer of people and
materials during a time of disaster.
•Agreements should be in place that address issues related to credentialing health care providers
who may be shared among institutions. Ex: The Medical Reserve Corps (MRC) in the USA was
initiated in 2002 to improve the health and safety of communities across the country by
organizing and utilizing public health, nursing, medical, and other volunteers who want to
donate their time and expertise to prepare for and respond to emergencies.
•Plans also need to be developed with school systems or other large facilities to provide shelter
for large number of victims.
Preparedness Phase
•The interface with volunteer agencies, such as Red Cross, also needs to be arranged.
•Agencies should have well-developed emergency operating plan (EOP) that includes
1)capabilities for responding to MCE, 2)an identified chain of command, 3)plan for interaction
with other community agencies.
•Agency personnel should be knowledgeable about their role in the EOP and receive education
concerning ways to respond to all types of hazard.
•The National Response Framework (USA) is a guide to how the nation conducts an all-hazard
response – from smallest incident to the largest catastrophe – using comprehensive , national,
all-hazard approach to domestic incident response.
Preparedness Phase
•Several federal-level programs are designed to assist communities in planning their emergency response
to an MCE and to provide assistance during a time of disaster. Key components of the federal response
system are:
The Metropolitan Medical Response System (MMRS)
•a cadre of specialty trained responders and equipment.
•The system is coordinated with area and statewide planning systems and integrates the efforts of all of the
emergency response teams.
•The MMRS includes plans for expanding hospital-based care, enhancing emergency medical transport and
emergency department capabilities, locating specialized pharmaceuticals to respond to an MCE, managing
mass fatalities, and providing mental health care for the community, victims, and health care providers.
•Scenarios designed to test the effectiveness of the MMRS in community are conducted on a regular basis.
Preparedness Phase
The National Disaster Medical System (NDMS)
• a federally coordinated system that augments the nation’s medical response capability during
times of major peacetime disasters.
• to provide support to the military and the Department of Veterans Affairs medical systems in
caring for casualties evacuated back to the United States from overseas armed conventional
conflicts (U.S. Dept. of Health and Human Services [USDHHS], 2012).
•The National Response Framework utilizes the NDMS to support the federal medical response to
major emergencies and federally declared disasters including national disasters, major
transportation accidents, technologic disasters, and acts of terrorism.
Preparedness Phase
The Commissioned Corps
•An emergency response teams managed by the Office of the Surgeon General and are part of
the U.S. Public Health Service.
•These teams are an additional asset capable of responding in times of extraordinary need when
the public health needs exceed the ability of the local or state agencies.
•The Commissioned Corps is composed of more than 6500 health care professionals that can be
deployed to respond to a disaster, either as a large group or in small numbers to support the
disaster medical assistance team’s (DMAT) effort.
 Preparedness Phase
Strategic National Stockpile
•The Centers for Disease Control and Prevention (CDC) host a Strategic National Stockpile (SNS) that has large
quantities of medicine and medical supplies if there is a public health emergency severe enough to cause
local supplies to be depleted.
•The SNS has a national repository of antibiotics, chemical antidotes, antitoxins, IV administrations, airway
supplies. A 12-hour “push-pack” of supplies can be deployed within 12 hours of the decision to activate the
SNS.
•The community emergency plan should include procedures to receive the push package. Follow-up
pharmaceutical or medical supplies can be shipped within 24 to 36 hours if required. This supply can be
tailored to the specific needs of the event if the needs are known at that time.
•individuals and households can contribute by preparing emergency supply kits and household emergency
plans, and monitoring emergency communications carefully.
Relief Response Phase
Response Activities
•first initiated during the impact phase of disasters, activities begin at the time of the event and are
focused on providing the first emergency response to victims of the disaster, stabilizing the situation,
and providing adequate treatment for the victims.
•This phase requires the interaction of emergency responders from fire and police departments,
emergency medical services, hazardous materials teams, health care agencies, health departments,
and other agencies to be able to triage and provide assistance to the victims and stabilize the scene.
•Usually the first unit responding establishes an incident command post from which to coordinate the
activities. However, as other units arrive and as the cause of the incident becomes known, one of the
law enforcement agencies may assume control if there is suspicion of a crime before the
establishment of a community-based emergency operations center (EOC).
Relief Response Phase
The National Incident Management System (NIMS)
•provides a systematic proactive approach to guide departments and agencies at all levels of government,
nongovernmental organizations, and the private sector to work seamlessly during disaster situations.
•An efficient NIMS requires a hierarchic chain of command led by the incident manager or commander.
Job assignments are consistently followed by assigned personnel who refer to a specific job action sheet.
NIMS will be established at the scene of the disaster and include representatives of all agencies needed
to provide the emergency services.
•At the time of a mass casualty, each hospital system will initiate its emergency response plans using the
system called the hospital incident command system (HICS). The assumption is that in a time of crisis,
communication will be improved if all disaster responders begin from a common structure. The HICS
defines responsibilities, reporting channels, and common terminology for hospitals, fire departments,
local governments, and other agencies
Relief Response Phase
Personal Protection and Safety
•Personal protection and safety are important. The lives of emergency responders takes
precedence over other incident issues because if emergency responders are exposed or injured,
they will not be able to provide care to others.
•Because of the varied routes of exposure from CBRNE agents, personal protective equipment
(PPE) must be designed to impede the most vulnerable route(s), thereby blocking the agent
from entering the body. Specially designed PPE is available in a variety of levels designed to
meet specific protection needs:
Level A provides a totally encapsulated chemical resistant suit, including supplied air. As a result,
maximum respiratory and skin protection is provided. This level of equipment is used to provide
protection against liquid splashes or in situations in which agents are still unidentified.
Relief Response Phase
•Level B provides a chemical splash–resistant suit with hood and self-contained breathing
apparatus (SCBA). It provides maximum respiratory protection but less skin protection than level
A equipment.
•Level C equipment is chemical-resistant clothing with a hood and an air-purifying respirator. The
respirator can remove all anticipated contaminants and concentrations of chemical materials,
thus providing adequate protection against airborne biologic agents and radiologic materials.
•Level D protection may consist of a uniform or scrubs and is appropriate when it has been
determined that no respiratory or skin hazard is present.
Recovery Phase
• Activities designed to return responders and facility to full normal operational status and to
restore fully the capability to respond to future emergencies and disasters.
•During recovery phase, a network of activities is designed to enhance rehabilitation and
reconstruction like individual and public assistance programs including:
providing temporary housing assistance
grants and loans to eligible individuals and government entities to recover from the effects of
disaster.
•The recovery phase usually begins 72 hours after the disaster and may continue for 2 to 3 years
 Communication Within the
Health Care Facility
•At the initial time of the event, it is crucial for the facility information officer to communicate with the
news media and for administrators to communicate with the health care facility to prevent group panic.
Communication officers need to:
(1)Determine the effects the crisis will have on the audience. (2) Speak clearly and simply about the facts.
(3) Be direct, honest, and to the point. (4) Reassure and calm the audience.
•Regular updates of information (every 30 minutes) need to be planned and distributed to all hospital units
as quickly as possible
•Patients and families need to be informed of measures that will be taken with the initiation of the EOP,
such as early discharge or relocation of less ill patients to other areas of the hospital or to other facilities.
•Family members may not be able to leave the hospital to return home; arrangements will need to be
made to care for them, including providing medications that they take regularly.
Biologic Causes of Mass
Casualty:
Pandemic Influenza
•A pandemic influenza is a global outbreak that occurs when a new influenza type A virus
emerges in the human population, causing serious illness and death as it spreads worldwide.
•Rarely happens. Three worldwide (pandemic) outbreaks of influenza occurred in the 20th
century: 1918, 50 million died worldwide; 1957, 1 to 2 million died worldwide; 1968, 700,000
died worldwide
•The threat of pandemic flu was heightened in 2009 because of the H1N1 virus (swine flu) and
H5N1 virus (avian flu) outbreaks.
•Because the virus is new to humans, most people have little or no immunity because they have
no previous exposure to the virus. Vaccine may not be available in the early stages of a
pandemic flu. Regular flu shots are designed for a specific strain of flu and thus will not provide
immunity to the various types of flu such as H5N1 or H1N1.
Biologic Causes of Mass
Casualty:
Pandemic Influenza
•In 2006, Cambodia, China, Indonesia, Thailand, Iraq, Turkey, Vietnam, and Egypt reported
human deaths from H5N1 virus after coming into contact with infected birds or contaminated
food.
•Mortality rate for H5N1 virus was initially 50% to 70% for human cases. The infected birds
moved from Asia to Europe and Africa.
•In 2009, the H1N1 virus rapidly spread to the United States and other countries and was initially
predicted that the H1N1 virus would have a high fatality rate, but the virus was less virulent than
predicted. WHO declared the H1N1 pandemic over in August 2010.
•The CDC and the WHO have developed surveillance mechanisms to determine phases of
pandemic alert, which includes decisions on when to move from one phase to another. Figure
15-3 provides the details related to the six phases of alert.
Biologic Causes of Mass
Casualty:
Pandemic Influenza
•Phase 1 no viruses circulating among animals have been reported to cause infections in humans.
•Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have
caused infection in humans, and is therefore considered a potential pandemic threat.
•Phase 3, an animal or human-animal influenza virus has caused sporadic cases or small clusters of
disease in people, but has not resulted in human-to-human transmission sufficient to sustain
community-level outbreaks. does not indicate that the virus has gained the level of transmissibility
among humans necessary to cause a pandemic.
•Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal
influenza reassortant virus able to cause “community-level outbreaks.” WHO should be consulted to
jointly assess if implementation of a rapid pandemic containment operation is warranted. Phase 4
indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a
forgone conclusion.
Biologic Causes of Mass
Casualty:
Pandemic Influenza
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in
one WHO region. While most countries will not be affected at this stage, the declaration of
Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the
organization, communication, and implementation of the planned mitigation measures is short.
Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one
other country in a different WHO region in addition to the criteria defined in Phase 5.
Designation of this phase will indicate that a global pandemic is under way.
During the post-peak period, pandemic disease levels in most countries with adequate
surveillance will have dropped below peak observed levels. The post-peak period signifies that
pandemic activity appears to be decreasing; however, it is uncertain if additional waves will
occur and countries will need to be prepared for a second wave.
Biologic Causes of Mass
Casualty:
Pandemic Influenza
•In the post-pandemic period, influenza disease activity will have returned to levels normally seen
for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A
virus. At this stage, it is important to maintain surveillance and update pandemic preparedness
and response plans accordingly. An intensive phase of recovery and evaluation may be required.
•As with other MCEs, planning aimed at saving the largest number of people include:
using Control methods (isolation, quarantine, and restrictions) and Limitations (suspension of
large public gatherings, school closures, and social distancing).
•Social distancing refers to the attempt to keep people as far apart as possible to limit the
possibilities of spreading germs. The most recommended type of social distancing proven to be
effective for H1N1 virus was to keep people suspected of the illness at home until 24 hours after
the fever has subsided.
Biologic Causes of Mass
Casualty:
Pandemic Influenza
Health care providers are advised to treat patients symptomatically without encouraging them
to come to offices or emergency departments.
Health care facilities set up separate screening facilities for those who have flulike symptoms.
Teach family members how to cover their mouths when coughing, how to appropriately
dispose of used tissues, and how and when to wash their hands.
Develop contingency plans to address school and business closures, unavailability of public
transportation, and disruption in social activities.
Personal stockpiling of food and medications to get through this event with minimal contact
with others.
References:
Cherry, B., & Jacob, S. R. (2014). Contemporary Nursing: Issues, Trends, & Management (6th ed.).
St. Louis, MO: Elsevier Health Sciences.
Kilbourne, E. D. (2006, January). Influenza Pandemics of the 20th Century. Retrieved November
29, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291411/
Current WHO phase of pandemic alert (avian influenza H5N1). (n.d.). Retrieved November 29,
2017, from http://www.who.int/influenza/human_animal_interface/h5n1phase/en/