The role of major health personnel in an emergency is to manage the safety and well being of the people in their community during and after a natural or man-made disaster. This is done by assessing the details of what occurred, what needs must be met and facilitating a team to organize information about the event and provide logistics as quickly as possible.
This is seen in the simulation exercise for the “Disaster in Franklin County”. (Olson, Larsen, Scheller, & Johnson, 2006) Roles are appointed in a chain of command format. It is ideal that all personnel have received some type of emergency management training, but even if not, skill sets must be assessed and duties assigned accordingly. An Incident Commander will be appointed and the public health Director assigns rolls that include finances, planning, logistics, public information liaison and operators.
The Public Health Team will work closely and concurrently with other entities, such as the Fire Chief, Police Chief, Hazardous Materials Team, Public Works and EMS teams. The public health department is mostly concerned with the safety and logistics of sheltering victims and being sure that food and water provided is safe for consumption. The community health nurse is primarily concerned about the immediate welfare and safety of the public, including issues of safety in homes, sanitary food options and safe water availability.
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It is important to have press releases ready to go that are clear and informative, yet simple. Any public statement made by the nurse should be thoughtful and considerate, assuring the community that they are in good hands and that things are being taken care of by appropriate people and in a timely manner. Public Service Announcements (PSAs) are an opportunity to gain trust and respect and show competence and compassion. In the Franklin County scenario, the public health nurse is assigned to do door-to-door interviews in an area of town hit the hardest by flood damage.
The nurse is assessing for personal safety, being certain that there are no medically fragile patients, home bound persons or persons with special needs. Without electricity, a patient that requires at home oxygen, nebulizers, chemo or dialysis will need to be assisted to a shelter. Families with infants must be comfortable with an abundance of supplies. Contamination risks from food spoilage must be made aware, and the nurse must assess if he or she believes that the family has the means to safely prepare meals and have access to clean water.
Finally, the nurse assesses for structural safety and advises community members on whether or not they should consider relocating to a shelter. With the uncertainty of going door-to-door, a nurse must be prepared to assess needs that are out of their scope of practice. They must be prepared to offer resources that may be out of their area of expertise. Situations that occur may range greatly, such as difficulty with foreign language communication, to chemical spills in yards or improper use of a generator.
In cases such as this, the actions of the community health nurse must be resourceful and know that he or she can call on other professionals to reach out where they needed. A family with chemical leakage from flooding may be guided to a shelter for their immediate safety and the community health nurse may follow up by asking an Environmental Director to assess the property, instead of offering wrong or false advice to the homeowner. Natural and man-made disasters not only put community members at a physical risk, but also at emotional risk, as situation arise as homes are destroyed, insurance issues arise, or being separated from loved ones.
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The public health nurse also needs to take action and be resourceful in providing appropriate referrals for mental health, including providing phone numbers, access to call or reach out, and to follow up and be sure that there is enough man-power to assist with answering phones or counseling people. Techniques that were used were active listening and repeating statements back, validating that their thoughts and fears are heard. Assurance was given that the situation was grave, but not hopeless. Encouragement was provided to make appropriate, yet difficult, decisions such as leaving one’s house and personal belongings in a time of crisis.
In widespread disaster scenarios, that affect greater areas, such as Hurricane Katrina, not only are public nurses needed, but it is important that nursing personnel from hospitals and state health departments are involved. In times of crisis, all professionals need to be on the same page to avoid offering mixed messages or advise to the public. Basic training in emergency management should be provided for all health care professionals. Emergency communication must also be set in place, as with no electricity or land lines, there must be agreed upon and practiced means of communication between all emergency responders.
In area with high incidences of particular storms, flooding or power outages, PSA’s can be prepared ahead of time and are ready to go during times of crisis with minor modifications. The community health nurse is an import piece of the emergency management team, and is a direct liaison between the public and the resources.
