Emergency response requires a chain of command. There are many different roles in the emergency response team. Public health nurses fulfill a role on this team. They must deal with situations outside their scope of practice by utilizing alternate resources. These nurses are in the community to assess needs and provide information on options. It is important public health nurses are prepared to help in responding to emergencies. Role of Public Health Personnel Disasters occur leaving devastation behind. Public health personnel play a major role in assessing, providing for and educating the community.
The first critical component during a public health emergency is to establish an Emergency Operations Center (EOC) and assign roles to trained public health officials based on individual skill sets. This responsibility lies with the Incident Commander. A Public Health Incident Command System starts with an Incident Commander who is the lead person and usually one of the first persons on the scene. It is the role of the commander to oversee all operations of the disaster. He or she will develop action plans and objectives after assessing the situation. Disaster in Franklin County A Public Health Simulation, 2005). Public health officials are trained on their specific roles and responsibilities during an emergency.
The specific roles and there responsibilities are as follows: Public Information Officer assures that public health information is appropriate and provided to the public. They must to keep staff appropriately informed and work with all agencies so that the messages are consistent. Liaison Officer serves as the point of contact for all other agencies. They answer questions and give briefings keeping the Incident Commander free for other duties. Disaster in Franklin County A Public Health Simulation, 2005). Operations Chief organizes, assigns and supervises the people who are available to help in the field. He/she develops and implements plans and methods to achieve the objectives. Planned field personnel are the community service branch director, medical/health director which includes the public health group, fire branch director, public works branch director and law enforcement director. (Disaster in Franklin County A Public Health Simulation, 2005). Planning Chief gathers analyzes and shares the information.
It is their function to manage the planning process and make an action plan. They are always thinking of what comes next. (Disaster in Franklin County A Public Health Simulation, 2005). Logistics Chief is the person that is able to obtain the necessary things to complete the tasks. They are able to acquire supplies, equipment and space if needed. (Disaster in Franklin County A Public Health Simulation, 2005). Finance/Administration Chief monitors contractual and financial processes. They ensure the proper contracts are in place and track what and where resources are being used. Disaster in Franklin County A Public Health Simulation, 2005).
The Public Health Nurse is responsible for assessing people’s needs. The nurse may need to provide education on safety, food storage, and sanitation and health hazards. It is the nurse’s responsibility to make referrals to other public health teams if he/she encounters something outside their scope of practice such as hazardous materials disposal. He/she will assist with identifying acute medical issues and ensuring residents have basic necessities, such as safe drinking water and food as well as medications and medical equipment.
The public health nurses will need to be available in the community as people are able to return to their homes to assess for newly arising health issues. Chain of Command In the Franklin County Simulation the Emergency Operations Center Commander, Chris Newhouse directed the Operations Chief, Rebecca Brower. She was responsible for the Medical/Health Branch Director, Zachary Burke. Mr. Burke directed the County Public Health Director who then directed the public health nurse. (Disaster in Franklin County A Public Health Simulation, 2005). Resources
Encountering situations outside of the community health nurse’s scope of practice would require the nurse to utilize alternate resources. There are multiple other team members to make the appropriate referrals to, for example if the person does not have adequate shelter or food and water the nurse can refer them to a shelter and inform the community service branch director and logistics chief. Perhaps there is an issue with chemical spill in the home or a gas leak; the nurse could utilize the environmental health specialist and public works branch director.
Actions for Door-to-Door Interviews Potential Emergency Situations Potential emergency situations can be encountered by nurses when conducting door-to-door interviews. The nurse must assess the situation and take appropriate action. Jason Fugate informed the nurse he had utilized his last dose of blood pressure medication and was now unable to get it picked up. First the nurse took his blood pressure to ensure it was within a safe range, determining his blood pressure was stable, she then offered choices to Mr. Fugate.
She provided him the options of having medication delivered to him the following day or being relocated to the shelter in town where he would have access to services. It is important to let the resident know they have options and what those options are and to participate in the decision making when possible as this helps them to feel like they have some control. Rosario Alvarez was unable to answer the questions the nurse asked. It was discovered Rosario was Spanish speaking only and utilizing the limited Spanish the nurse knew she was able to discern there was an English speaking person available.
Education for this residence on safe use of a generator was necessary and would need to be provided in Spanish and English. The nurse established she would need an interpreter on subsequent visits as well. Coping After Flooding Flood victims often have problems dealing with the aftermath, emotional as well as property damage. They often sustain property loss or damage that they must address while dealing with the disruption to their life. Susan Fuhr expressed lack of supplies, additional responsibility of having her mother-in-law to care for and lack of support from her spouse.
Providing Susan with options of staying home and having supplies sent, coming to shelter where supplies were available as well as assistance or sending social services out to provide alternate resources such as counseling allowed Susan to be involved in the decision process and helped to give her some control. Techniques that can be used to calm fears in the aftermath of disaster are to provide emotional support, reassurance that things are being taken care of and give accurate consistent information. Emotional support can be provided in several ways.
Let the person know you are there for them by physically being there. Be willing to sit in silence and offer your presence. Offer a hug or touch on the hand. Acknowledge the situation and their feelings. Allow them to express their feelings and offer your support. Ask what you can do for them, offer practical assistance. Stay in touch by periodically checking in, dropping by or calling. Watch for resolution of symptoms/fears and if necessary make referral for mental health services if available and then follow up to ensure services are provided.
Reassurance is restoration of confidence. Assure them by encouraging them to look at each task accomplished as forward progress. Provide visual support of improvements with updates daily or weekly. Accurate consistent information is necessary for people to have confidence in the messenger. Provide known correct facts. If you do not have the answer to a question, state “I do not know, but I will find out”, then find out the answer and provide the information you have discovered. If they information may change state that also. Nursing Personnel Preparation
Nursing personnel could be prepared to respond to an emergency of a larger affected area by having specialized education in each area of disasters. Specialty education for geographical area, the type of disaster most common for said area, for example, floods versus tornado. They should know what are the most likely effects of said disaster and what roles the nurse might be called upon to fill. Public health nurses should be educated on disaster protocols and preparedness. They should know their community disaster plan and warning system. They need to know their role as well as who would fill the other roles.
It is important that they know the available resources so they can make referrals as needed. They need to know the patient environment and resources for assistance such as relatives or neighbors. Public health nurses should be skilled in emergency triage and evacuation procedures. They need to know how to assess what poses the greatest risk to the patients and how to minimize this risk. They should know what the capabilities are of the community. This knowledge should be the basic principle for preparation and prevention in disaster situations.