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By encouraging preparedness efforts, hazard identification and mitigation the community can minimize the effects of a disaster and facilitate recovery. Nurses for disaster management must prepare their families, neighbors and communities to respond appropriately to terrorism and disasters of all types. Public health nurses and other health care professionals work with local emergency management agencies to prepare people to evacuate, and assure evacuation plans for people with special needs in home care, hospitals, and nursing homes. Individuals who are particularly vulnerable to exposure, such as the elderly, women and children, and persons with disabilities need extra awareness, preparedness, and interventions. The provision of medical care, prescription medications, shelter, food and water safety, sanitation, should be ensured. A disaster-preparedness plan, a formal written plan of action for coordinating the response of a hospital staff in the event of disaster within the hospital, the primary care facility or the surrounding community. These plans serve as a basis for how to best utilize resources when the medical facilities are under heavy pressure, and are continuously updated and should be well known by staff.
Assessment of response capacity, preparedness plans, and training of hospitals and other health care providers as well as, work to ensure communication possibilities with police, fire departments and other emergency responders, to be able to cope in the event of a crisis, bioterrorist attack, natural disaster or a pandemic is essential. Ideally, local public health and health care facilities, other responders, are integrated into a community-wide plan that is exercised and evaluated.
The book "Public Health Management of Disasters: The Practice Guide, 2nd Edition" (Landesman, 2005), published by the American Public Health Association, is a reference on the public health aspects of disaster/emergency response, management and planning. The importance of disaster communications is stressed, and a list of agencies and contracts is provided in the appendices, pertinent Web sites, components of a first aid-kit, key elements of a public health preparedness program, incident commanders’ checklist and many more.
The CDC, the American Red Cross, and the Department of Homeland Security provide information about emergencies, emergency preparedness and what to do in the event of a bioterrorist attack. Bioterrorism agents can be separated into three categories, depending on how easily they can be spread and the severity of illness or death they cause. Category A agents include organisms and toxins that pose the highest risk to the public and natural security; category B agents are considered more moderate; and category C agents are those that are considered emerging threats for disease and include emerging pathogens for possible mass spread in the future.
More than 90 percent of the injured must be rescued within 48 hours. Experience show that the chance to found survivors after three days is very little. Local responses and relief actions in the acute phase (0-48 hours) include assessment of injuries, and health effects, to establish medical triage centers and rescue efforts for victims and to reestablish broken communications. Quick assessment of health effects include: immediate effects, number of injuries, effects on medical and other related facilities and health care staff; local resources; water- and power supply; medical- and equipment storage; food storage; sewage and sanitation; and determination of help needed from outside. In the sub acute phase actions are taken to evacuate victims, provide food and water, continue treatment of injured and vaccinations, follow-up of mortality and morbidity surveillance, information and communication.
American Public Health Association (American Public Health Association, 2005, 2) has listed twelve tasks or problems that are likely to occur in most disasters (these are briefly summarized below):
Disruption of shelters, utilities, communication systems, and transportation (public health officials must develop the capacity, to participate in coordinated, multiorganizational response to unexpected problems).
Focus in the aftermath of disasters, along with providing emergency relief might be preventive vaccinations, and support of people’s needs through primary healthcare in mobile and fixed clinics. Shelter, food and water, sanitation, hygiene kits need to be distributed. Active disease surveillance is part of all clinical programs, and psychosocial programs for meeting the psychosocial needs of disaster victims. Fear and sadness can be overwhelming for the survivors, and physically disabled victims. Traumatic events can cause posttraumatic stress disorder (PTSD) that may cause flashbacks, in which the person feels as if the traumatic event is recurring.
Advice lines and information centers should be expanded during a flu pandemic, biological terror attack, or other public health emergency, according to a new government report developed for the U.S. Agency for Healthcare Research and Quality by Denver Health Medical Center. The report is available online at www.ahrq.gov/prep/callcenters/callcenters.pdf. The report "Adapting Community Call Centers for Crisis Support: A Model for Home-based Care and Monitoring" offers guidelines for responding to callers’ concerns about health risks, as well as the collection of disease data, monitoring, helping callers with medication, and identifying those who may need referral to mental health providers.
The US Centers for Disease Control and Prevention (CDC) and the Federal Emergency Management Agency (FEMA) have developed some guidelines for residents dealing with the aftermath of Hurricane Katrina (Clark, 2005). The CDC has also compiled a list of resources to prepare the professional for conditions that one might encounter in the disaster field. These include emergency wound management (CDC – Emergency Preparedness & Response, 2010), vaccine storage, and acute diarrhea. The CDC has even issued interim recommendations for relief workers. A list of links to information on toxicology and environmental health has also been posted by the United States National Library of Medicine (U.S. National Library of Medicine, 2005).
Experiences from natural disasters shows that help from other countries, often arrive too late, is of wrong dimension and many times of wrong nature. International help should be requested and be specified by local/national authorities to be of real help. Poor countries, where the most disasters occur, have difficulties to manage rehabilitation and rebuilding of disastrous communities and thus have a need of international help.