Disaster in Franklin County Jennifer Wadsworth Western Governors University Disaster in Franklin County Role of Major Public Health Personnel The roles of major public health personnel must be delegated properly in a disaster situation in order to facilitate effective action. In the incident presented, a chain of command was established and assignments given to the appropriate personnel based on their skills and experience. As a whole, this group reports to the Incident Commander, an individual that is responsible for managing the entire disaster operation and various teams involved in every level of disaster management.
In the first few hours following a disaster there are many things that need to be addressed. In the scenario presented, one of the initial messages that must be presented is water safety. Informing the public on the rationale of why their water is unsafe is important in helping them understand the necessity of boiling it before use to prevent illness. Also informing them of where they can obtain a safe water supply is crucial.
The availability of temporary shelters and housing is also important in the first hours and days following the storm since many people may have had to leave their homes due to flooding, loss of power, or structural damage. Making sure citizens understand the dangers posed by downed power lines and the steps they should take when encountering them is a health issue as well. Proper food storage and handling is also critical when there is a lack of power in many homes. Knowing how long food will last in an inoperable refrigerator or freezer will help prevent foodborne illness.
Other messages of importance in the weeks to follow include the topic of mold. While it may not be of the utmost importance initially, residents who have experienced flooding in their homes must be made aware of how to identify the source of the problem and how to treat and remove it in order to prevent any health risks associated with mold. Public health officials must assist in assessing shelter sites to ensure proper food handling, storage, and preparation. Ample and sanitary bathroom facilities must be assessed in order to arrange for additional portable services to be brought in if necessary. The living onditions that exist in the shelter must also be assessed in order to ensure individual privacy and personal safety. Tetanus was a concern for some citizens and the public health officials alerted area immunization clinics to who may be at risk for developing the illness as well as recommendations for vaccination by the Centers for Disease Control and Prevention (CDC). Safety of area restaurants and their ability to reopen came into question after the storm and public health officials, in cooperation with adjoining counties, worked to address the issue in a timely fashion in order to restore a sense of normalcy to the community.
They must all be inspected to ensure that all public health guidelines are being followed and that the establishment is structurally sound. Providing culturally competent educational materials to members of the community, including those that may not speak English, is important and would potentially address the clean-up of hazardous materials, downed limbs, and trees as well as proper treatment of private wells. In the scenario members of the public health team joined other emergency workers in assisting those residents that may be cut off from supplies due to flooding in their area.
Public health nurses assisted in door-to-door interview with those residents to address immediate health concerns or injuries that may have occurred as a result of the storm, as well as the availability of basic supplies. Basic physical assessments may be necessary in some situations. The nurse can address medication and medical equipment supplies, and the ability to use medical equipment such as nebulizers and oxygen concentrators.
A lack of power would leave people with certain health conditions at risk of major health complications. Evacuation to temporary housing or shelters may be a better alternative for some, especially those requiring dialysis or chemotherapy, and the public health nurse could assist in arranging it. The public health nurse was able to help coordinate the delivery of necessary medications to those in short supply, enabling the patient to remain in their home for the time being.
Safe food and water supplies would need to be addressed with homeowners. Information regarding the safe storage, handling, and preparation of food without power is a topic of concern. Inquiring as to any structural damage or flooding in people’s homes would allow the opportunity to provide helpful information pertaining to temporary housing, the need to boil water, and general personal safety. The public health nurse should also be available as residents return to their homes after flood waters have subsided.
She can provide basic health information to those with questions or concerns. In conjunction with other public health officials, the nurse can assist in providing information regarding proper clean up, disposal of hazardous waste, mold, and the safety of food that remained in the home while the residents were in shelters. Public health officials, including the public health nurse, should be present at any informational meetings held for the public.
They would be excellent resources for citizens that have questions regarding matters of health and safety and could supply written information for a variety of concerns, such as water and food safety, disease outbreaks as a result of the storm, and general health information including immunizations. Mental health issues may also arise as a result of the disaster and proving information on resources, as well as referrals, may be necessary. The Chain of Command The Emergency Operations Center (EOC) Commander is the individual responsible for the entire disaster recovery.
The Medical/Health Branch Director, in conjunction with the entire public health group, would report to the Commander and the EOC team regarding pertinent health issues that may arise. Those issues may require immediate action, or may be something that could arise during and after the clean-up from the storm. The public health group is a system unto itself known as the Incident Command System. The Deputy Director served as the Incident Commander and the remainder of the system was made up of individuals from the local health department.
The lead role of Operations Section Chief is responsible for developing and implementing a plan, as well as ways in which to achieve the goals they establish. All other members of the Public Health Incident Command System will report to the Chief. The Operations Chief will also help to organize, assign, and supervise other outside resources necessary for the success of the plan. Other roles that the Operations Chief assigns to members of the department include: Public Information Officer, Finance/Administration Chief, Planning Chief, Liaison Officer, and Logistics Chief.
The Public Information Officer is responsible for providing appropriate public health information pertinent to the disaster. They will be the media contact and will ensure that important information reaches the public in a timely manner to limit the risk of new health issues. They will also educate fellow public health staff so that they are able to act as a cohesive group with a consistent message. The Finance/Administration Chief will have an accounting background and will deal with any financial aspects that arise, such as payroll of employees and contracted workers brought on board specifically due to the storm.
The Planning Chief will be the point of contact for all information that is released to the public regarding the disaster. The documentation they provide will be written in the languages necessary to ensure everyone affected by the disaster is informed. The Liaison Officer is the point of contact for outside resources, providing information and answering any questions they may have regarding the disaster or services needed. The Logistics Chief acquires things that Operations needs to get the job done such as space, supplies and equipment.
The Community Health Nurse would report to the Incident Commander and the members of the Incident Command System. Resources Available to the Community Health Nurse Throughout the disaster recovery, the community health nurse would certainly encounter situations that were beyond her scope of practice. There are many resources available to her and she would best serve her clients by utilizing the individuals from the Incident Command System. They would be able to put her in contact with people from mental health services to home repair.
The Logistics Chief would be an excellent resource in obtaining help from outside sources for sites for shelters, equipment and supplies. The Planning Chief would be a helpful resource in gathering and distributing culturally appropriate information to people who may speak a different language. Should the nurse not know who to go to regarding a specific need, she could go to the Incident Commander who would provide her with the necessary contacts. Social Services, Environmental Health employees, and independent contractors are only a few of the outside sources the public health nurse may be able to utilize.
Actions of the Community Health Nurse During door-to-door interviews following the storm, the community health nurse came across several situations that required immediate attention. In one instance, a homeowner had flooding in his basement and a chemical spill in his garage. The nurse had an environmental health specialist advise the homeowner on how to clean up the spill. She also made certain the homeowner was given information on mold and the best methods for cleaning his basement once the flood waters subsided. Another homeowner was overwhelmed with the entire situation.
She was immediately responsible for her mother-in-law, her baby, and her household. The nurse would be able to utilize several services in this situation. Providing basic provisions would allow the family to stay in the home should they wish to do so, however, a stay in a shelter would benefit everyone in the immediate situation given that they had lost electrical service. A social services consult would be beneficial to the family in the coming weeks if the mother-in-law remained in the home. At another residence, the client did not speak English and the nurse did not speak Spanish.
Therefore, she communicated through the son and was able to provide instruction on proper and safe use of a generator indoors. She also made certain to have information on proper food storage, handling, and preparation as well as generator use that was in English and Spanish, delivered back to the home with the accompaniment of an interpreter. At the home of another citizen the nurse discovered someone who was in need of blood pressure medication. The nurse assessed the man’s condition and, with the clients input, determined that the best solution was to arrange for evacuation to a shelter.
Coping with the Aftermath The community health nurse utilized several techniques to calm the fears of the people interviewed following the disaster. One of the main things that she did was to listen to them. When people had very specific concerns it was reassuring that someone was there to help. The ability to utilize resources to address their needs was of great help in reducing the anxiety level of those involved. The nurse also included each client in the decision making process regarding their individual situation.
Providing them with options and then discussing with them the benefits of choosing one over another allowed them to feel in control of their own situation. When disaster strikes, there is often a feeling of helplessness that overcomes people. The ability to choose for themselves gives back a sense of control and self-confidence. The nurse also made certain that things that required follow-up were completed. She made certain that information regarding food safety, mold, and hazardous material clean-up was disseminated to those returning to their homes.
She was also available to answer questions, on location as well as at community meetings. Techniques The community health nurse used several techniques to help calm the fears of her clients. She was calm and attentive to their needs. In situations of crisis, many people simply need someone to listen to their concerns. She made herself available to do so. She was informative and provided them with pertinent information to help them manage their day to day needs in the aftermath of the storm.
She addressed issues that some of the people had not considered and assisted them in coming to their own conclusions regarding their situations. Preparation for Disasters Community health nurses could help prepare themselves for such a situation by participating in mock disaster drills. Many cities have such programs, and becoming even more involved and helping to organize such an event would be an excellent way of learning how to respond to the immediate needs of patients when faced with an emergency situation.
The nurse is responsible for continuing education that includes emergency response and all public health nurses should be held accountable for maintaining those continuing education credits. Another way of preparing for such an emergency would be to research past situations to learn about the challenges that the health care professionals faced. Understanding what the needs are is the first step in preparing for a natural or man-made disaster.