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Nurses have a vital role to play in prevention, mitigation, and preparation. Become informed of the process of pandemics and social behaviors (e.g., theft, fear) associated with disasters that may be exacerbated by deteriorated living conditions. Nurses with technical skills and knowledge of epidemiology, physiology, pharmacology, cultural-familial structures, psychosocial issues, etc. can not only assist in disaster preparedness programs but help create them.
Nurses, as team members, can play a strategic role cooperating with health and social disciplines, government bodies, community groups, and non-governmental agencies, including humanitarian organizations. Become aware of associated physical and mental health, socio-economic, and nursing needs. Nurses who have prepared themselves to assist can also:
In addition to a well designed disaster plan, the community will need to be prepared to meet many of the response challenges with limited governmental resources. Other problems will arise. For example, Public Health nurses will need to have a community plan to educate local residents on subjects like caring for milder cases of illness/disease at home and recognizing when a professional care giver is needed
It is important for nurses to build relationships with public health officials, community stakeholders, private and public medical providers, and school officials. Working with infectious disease specialists and speaking to those in surveillance can assist in building relationships. Nurses must know about public health laboratories and their partners at CDC, federal and state agencies and other organizations engaged in complementary activities. There will also be the need to plan for rationing care (who will make the decisions?)
Public health nursing plans and disaster preparedness must include plans to deal with shortages of:
If people are prepared through education then they can know how to behave and what to expect when illness strikes. Patients with a co-morbid illness such as diabetes, COPD, or heart disease are the highest risk for developing pneumonia, needing hospital support, and ventilator support. They could be in the hospital for 10 days or longer. Each hospital community should assess on its own capability or anticipated capability in case of pandemics or epidemics or other emergency.
FluSurge is a spreadsheet-based model, which provides hospital administrators and public health officials’ estimates of the surge in demand for hospital-based services during the next influenza pandemic. FluSurge estimates the number of hospitalizations and deaths of an influenza pandemic (whose length and virulence are determined by the user) and compares the number of persons hospitalized, the number of persons requiring ICU care, and the number of persons requiring ventilator support during a pandemic with existing hospital capacity.
The nurse can:
Individual action is perhaps the most important element of disaster/pandemic preparedness and response. The critical role of individuals and families in controlling a pandemic cannot be overstated.
An illustration of influenza transmission vividly illustrates the impact of one individual’s behavior on the spread of disease, showing that an infection carried by one person can be transmitted to tens or hundreds of others.
Education on pandemic preparedness for the population should begin before a pandemic, and it should be provided by all levels of government and health care providers, and should occur in the context of preventing the transmission of any infection, such as the annual influenza or the common cold.
The goals of disaster preparedness are to anticipate, mitigate, and rehabilitate. Since nurses practice within unique state legislative niches, the profession should contribute to the policy-making process. The nursing role may change or expand during times of crisis. There should be a framework for expanded scope of practice and the assumption of nontraditional roles during times of emergency.
Many resources are available to train and prepare clinicians on an individual basis. This includes gathering information on personal and family preparation. The nursing profession, through its organizations, should address issues of professional education and legislation.
According to the CDC recommendation, all patients who present to a health-care setting with fever and respiratory symptoms should be managed according to recommendations for respiratory hygiene and cough etiquette and be questioned regarding their recent travel history.
These precautions should be continued for 14 days after onset of symptoms until an alternative diagnosis is established or until diagnostic test results indicate that the patient is not infected with influenza A virus. Patients managed as outpatients or hospitalized patients discharged before 14 days should be isolated in the home setting on the basis of principles outlined for the home isolation of SARS patients. (Another opportunity for education.)
Isolation precautions identical to those recommended for SARS should be implemented for all hospitalized patients diagnosed with, or under evaluation for, influenza A (H5N1) as follows:
The most important warning signal comes when clusters of patients are detected with clinical symptoms of influenza, closely related in time and place, as this suggests human-to-human transmission is taking place. For similar reasons, the detection of cases in health workers caring for H5N1 patients would suggest human-to-human transmission. Detection of such events should be followed by immediate field investigation of every possible case to confirm the diagnosis, identify the source, and determine whether human-to- human transmission is occurring.
Thus the purpose of public health surveillance is to have an ongoing program that assesses public health status, defines priorities, and evaluates research programs. Through this program an estimation of the problem’s magnitude can be determined as well as the geographic distribution of illness. Detection of epidemics/pandemics can be found by changes in health practices. Surveillance is best defined as a systematic ongoing informational collection, analysis, interpretation, and dissemination, with links to public health practice.
Enhanced surveillance efforts by state and local health departments, hospitals, and clinicians to identify patients at increased risk for influenza A (H5N1) and SARS. The clinical presentation and travel history of persons with influenza A (H5N1) or SARS infection may overlap.
Look for:
Numerous resources exist for nurses who wish to become better prepared to respond to disaster events such as terrorist attacks. One can contact emergency management to review a local community’s disaster plan to determine hazards, the role of various agencies and organizations, and other key information. Organizations such as the Red Cross provide education/training opportunities as well as other organizations.
It’s imperative that every nurse be familiar with his or her employer’s disaster plan. Finally, nurses should realize that they will be viewed as potential sources of accurate information by their families, friends, and communities, and should take steps to become as knowledgeable as possible about disaster preparedness and response.
Biosecurity has three major components regardless of whether avian influenza, SARS, or intentional release.
Isolation refers to the confinement of animals within a controlled environment. A fence keeps birds in, but it also keeps other animals out. Isolation also applies to the practice of separating birds by age group.
Traffic control includes both the traffic onto the farm and the traffic patterns within the farm.
Sanitation addresses the disinfection of materials, people and equipment entering the farm and the cleanliness of the personnel on the farm.
Nurses would most likely be designated and recognized as first responders in mass casualty emergencies, including those resulting from bio-terrorists. School nurses are the only professional health care providers in most schools; therefore, schools are vulnerable as well.
Nurses should become as educated as possible regarding different kinds of influenza, and learn how to recognize early H5N1 signs. In addition, becoming politically active by lobbying representatives for financial allocations would be appropriate.
Nurses can become proactive, and prepare for any disaster or social problem if a disruption of services occurs. Incorporate disaster preparedness awareness in educational programs and provide continuing education to ensure a sound knowledge base, skill development, and ethical framework for practice. Planning at home or workplace is essential.