Topic: Discussion: Disaster Planning

Details: Discussion: Disaster Planning

Scenario: You are the PHN working at your local public health department in the nursing division. It is the middle of summer, and you have been receiving telephone calls asking about “the flu season” since the vaccine wasn’t accurate in predicting the strains of influenza that affected your community last year, and many people contracted the virus. Business and community leaders are concerned because they don’t want a repeat performance of last year. You have been asked to develop some solutions to community concerns. Select two of the following scenarios and respond to the questions that are posed in each. As you consider the scenarios you have selected, think about the following considerations as you develop your responses.
Which agencies are available to lead and assist in the disaster response?
What resources are available in your community?
How might resources be used most efficiently?
Are there any gaps that may pose a problem?
Identify potential strengths and weaknesses in the community
Scenario 1: Imagine that initial pandemic flu cases have been identified in your jurisdiction. Some people are homesick, and others are staying home fearful that they may become infected with the flu. What advice would you give to local business owners to prepare for this event? Name two actions that business owners can take to keep their businesses open.

Scenario 1, Part B. As incidents of influenza continue to rise, local business owners are worried about the loss of revenue if several large planned conventions are forced to cancel due to the flu. What advice can you give these business owners? Should all events be canceled?

Scenario 2: Disease rates are rising, and estimates are that as many as 20% of the population are ill with confirmed influenza. Several businesses have closed and services have been suspended. What advice would you give to local law enforcement officials so they can continue to serve the needs of the people? Describe two actions that law enforcement workers can take to remain on the job. How will the gaps in personnel created by those who are ill be covered by those who are still well? What advice will you give?

Scenario 3: Disease rates are remaining at 20% of the population, and many schools have closed due to teacher absence. Since parents still have to work if they are not sick with the flu, what advice can you give daycare providers? What two ideas can you share with them so they can stay open and able to care for the children of working parents? Should all school sporting events be canceled? What information should parents be given? Should announcements be given daily?

Scenario 4: The number of influenza victims has reached 25% of the population. Many of the large grocery stores in your community are short-staffed due to employee sick calls. Shelves are bare since many of the workers are home with the flu, and even if the store owner could stock the shelves, cashiers are homesick, too. In-store pharmacists are struggling to keep their pharmacies open to serve the public. Consumables like bread and milk are in short supply since many delivery drivers are homesick. What two actions can you recommend to these store owners so that your community doesn’t suffer?

Scenario 5: With 25% of the total population sick with influenza, your hospital is short of staff at a time of the very high census. While many of the administrative positions are unaffected by illness, at least 40% of the nurses have called in sick or are at home caring for very sick children. Name two recommendations that you can give your hospital administration to keep their services available for the community.

Scenario 6: The community is turning to the Health Department for assistance because reported incidents of influenza have risen from 5% of the population to 10% of the population in a matter of days. What is your first response to this situation? What steps will you take? Where will you start?

By Day 3

Post your response to this Discussion.

Support your response with references from the professional nursing literature.

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

(Video) Newscaster: There’s a large path of destruction here in town. … pulling trees from the ground, shattering windows, taking the roofs off of homes …

00:21

Caitria O’Neill: That was me in front of our house in Monson, Massachusetts last June. After an EF3 tornado ripped straight through our town and took parts of our roof off, I decided to stay in Massachusetts, instead of pursuing the master’s program I had moved my boxes home that afternoon for.

00:39

Morgan O’Neill: So, on June 1, we weren’t disaster experts, but on June 3, we started faking it. This experience changed our lives, and now we’re trying to change the experience.

00:48

CO: So, tornadoes don’t happen in Massachusetts, and I was cleverly standing in the front yard when one came over the hill. After a lamppost flew by, my family and I sprinted into the basement. Trees were thrown against the house, the windows exploded. When we finally got out the back door, transformers were burning in the street.

01:05

MO: I was here in Boston. I’m a Ph.D. student at MIT, and I happen to study atmospheric science. Actually, it gets weirder — I was in the museum of science at the time the tornado hit, playing with the tornado display —

01:17

(Laughter)

01:18

so I missed her call. I get a call from Caitria, hear the news, and start tracking the radar online to call the family back when another supercell was forming in their area. I drove home late that night with batteries and ice. We live across the street from a historic church that had lost its very iconic steeple in the storm. It had become a community gathering place overnight. The town hall and the police department had also suffered direct hits, and so people wanting to help or needing information went to the church.

01:44

CO: We walked to the church because we heard they had hot meals, but when we arrived, we found problems. There were a couple large, sweaty men with chainsaws standing in the center of the church, but nobody knew where to send them because no one knew the extent of the damage yet. As we watched, they became frustrated and left to go find somebody to help on their own.

02:01

MO: So we started organizing. Why? It had to be done. We found Pastor Bob and offered to give the response some infrastructure. And then, armed with just two laptops and one air card, we built a recovery machine.

02:14

(Applause)

02:17

CO: That was a tornado, and everyone’s heading to the church to drop things off and volunteer.

02:22

MO: Everyone’s donating clothing. We should inventory the donations piling up here.

02:26

CO: And we need a hotline. Can you make a Google Voice number?

02:29

MO: Sure. And we need to tell people what not to bring. I’ll make a Facebook account. Can you print flyers?

02:34

CO: Yeah, but we don’t even know what houses are accepting help. We need to canvas and send out volunteers.

02:39

MO: We need to tell people what not to bring. Hey, there’s a new truck. I’ll tell them. CO: You got my number off the news? We don’t need more freezers!

02:46

(Together) MO: Insurance won’t cover it? CO: Juice boxes coming in an hour? Together: Someone get me Post-its!

02:52

(Laughter)

02:53

CO: And then the rest of the community figured out that we had answers.

02:57

MO: I can donate three water heaters, but someone needs to come to pick them up.

03:00

CO: My car is in my living room!

03:02

MO: My boy scout troop would like to rebuild 12 mailboxes.

03:05

CO: My puppy is missing and insurance doesn’t cover chimneys.

03:08

MO: My church group of 50 would like housing and meals for a week while we repair properties.

03:12

CO: You sent me to that place on Washington Street yesterday, and now I’m covered in poison ivy.

03:17

(Laughter)

03:18

So this is what filled our days. We had to learn how to answer questions quickly and to solve problems in a minute or less; otherwise, something more urgent would come up, and it wouldn’t get done.

03:28

MO: We didn’t get our authority from the board of selectmen or the emergency management director or the United Way. We just started answering questions and making decisions because someone — anyone — had to. And why not me? I’m a campaign organizer. I’m good at Facebook. And there’s two of me.

03:44

(Laughter)

03:45

CO: The point is, if there’s a flood or a fire or a hurricane, you, or somebody like you, are going to step up and start organizing things. The other point is that it is hard.

03:55

MO: Lying on the ground after another 17-hour day, Caitria and I would empty our pockets and try to place dozens of scraps of paper into context — all bits of information that had to be remembered and matched in order to help someone. After another day and a shower at the shelter, we realized it shouldn’t be this hard.

04:11

CO: In a country like ours where we breathe Wi-Fi, leveraging technology for a faster recovery should be a no-brainer. Systems like the ones that we were creating on the fly could exist ahead of time. And if some community member is in this organizing position in every area after every disaster, these tools should exist.

04:30

MO: So, we decided to build them: a recovery in a box, something that could be deployed after every disaster by any local organizer.

04:37

CO: I decided to stay in the country, give up the master’s in Moscow, and work full-time to make this happen. In the course of the past year, we’ve become experts in the field of community-powered disaster recovery. And there are three main problems that we’ve observed with the way things work currently.

04:53

MO: The tools.

04:54

Large aid organizations are exceptional at bringing massive resources to bear after a disaster, but they often fulfill very specific missions, and then they leave. This leaves local residents to deal with the thousands of spontaneous volunteers, thousands of donations, and all with no training and no tools. So they use Post-its or Excel or Facebook. But none of these tools allow you to value high-priority information amidst all of the photos and well-wishes.

05:19

CO: The timing. Disaster relief is essentially a backward political campaign. In a political campaign, you start with no interest and no capacity to turn that into action. You build both gradually, until a moment of peak mobilization at the time of the election. In a disaster, however, you start with all of the interest and none of the capacity. And you’ve only got about seven days to capture 50 percent of all of the Web searches that will ever be made to help your area. Then some sporting event happens, and you’ve got only the resources that you’ve collected thus far to meet the next five years of recovery needs.

05:51

This is the slide for Katrina. This is the curve for Joplin. And this is the curve for the Dallas tornadoes in April, where we deployed software. There’s a gap here. Affected households have to wait for the insurance adjuster to visit before they can start accepting help on their properties. And you’ve only got about four days of interest in Dallas.

06:13

MO: Data. Data is inherently unsexy, but it can jump-start an area’s recovery. FEMA and the state will pay 85 percent of the cost of a federally-declared disaster, leaving the town to pay the last 15 percent of the bill. Now that expense can be huge, but if the town can mobilize X amount of volunteers for Y hours, the dollar value of that labor used goes toward the town’s contribution. But who knows that? Now try to imagine the sinking feeling you get when you’ve just sent out 2,000 volunteers and you can’t prove it.

06:45

CO: These are three problems with a common solution. If we can get the right tools at the right time to the people who will inevitably step up and start putting their communities back together, we can create new standards in disaster recovery.

06:57

MO: We needed canvasing tools, donations databasing, needs reporting, remote volunteer access, all in an easy-to-use website.

07:05

CO: And we needed help. Alvin, our software engineer, and co-founder has built these tools. Chris and Bill have volunteered their time to use operations and partnerships. And we’ve been flying into disaster areas since this past January, setting up software, training residents, and licensing the software to areas that are preparing for disasters.

07:24

MO: One of our first launches was after the Dallas tornadoes this past April. We flew into a town that had a static, outdated website and a frenetic Facebook feed, trying to structure the response, and we launched our platform. All of the interest came in the first four days, but by the time they lost the news cycle, that’s when the needs came in, yet they had this massive resource of what people were able to give and they’ve been able to meet the needs of their residents.

07:47

CO: So it’s working, but it could be better. Emergency preparedness is a big deal in disaster recovery because it makes towns safer and more resilient. Imagine if we could have these systems ready to go in a place before a disaster. So that’s what we’re working on. We’re working on getting the software to places so people expect it, so people know how to use it and so it can be filled ahead of time with that micro-information that drives recovery.

08:10

MO: It’s not rocket science. These tools are obvious and people want them. In our hometown, we trained a half-dozen residents to run these Web tools on their own, because Caitria and I live here, in Boston. They took to it immediately, and now they are forces of nature. There are over three volunteer groups working almost every day and have been since June 1 of last year, to make sure these residents get what they need and get back in their homes. They have hotlines and spreadsheets and data.

08:34
CO: And that makes a difference. June 1 this year marked the one-year anniversary of the Monson tornado, and our community’s never been more connected or more empowered. We’ve been able to see the same transformation in Texas and in Alabama. Because it doesn’t take Harvard or MIT to fly in and fix problems after a disaster; it takes a local. No matter how good an aid organization is at what they do, they eventually have to go home. But if you give locals the tools, if you show them what they can do to recover, they become experts.

09:06

(Applause)

09:07

MO: All right. Let’s go.

09:08

(Applause)

Emergency Preparedness and Disaster Response in Community Health Nursing
© 2016 Laureate Education, Inc. 1
Emergency Preparedness and Disaster Response in Community
Health Nursing
Program Transcript
NARRATOR: This week, our experts share their experiences with emergency
preparedness and disaster response.
[MUSIC PLAYING]
FERNANDO GUERRA: With the Katrina and Rita hurricanes of just a few years
ago, when suddenly in my community of San Antonio, which is not so far from
New Orleans, and because of some capacity that we had established there we
suddenly within a matter of 24 hours were serving as host for about 25,000
people that were being evacuated from their communities along the Gulf Coast.
That was a real challenge to certainly quickly muster up the capacity and the
response capabilities to provide shelter, to provide food, to provide medical
services, to provide triage not just for one or two days, this was going to be for a
period of several days.
So when you have something at that level that is really a formidable challenge or
something that is a much smaller challenge, that really keeps one very tuned into
the what-ifs. Our public health response is not quite at the level that it should be.
JOAN M. MARREN: Well, I think that the September 11 attack has changed our
organization dramatically in some ways and not changed our– and much has
remained the same. One of the extraordinary observations for me on September
11 was that on September 11, our organization had probably a census of close to
1,400 patients who lived in the zone that became frozen and cordoned off– well,
the whole city was locked down for some period of time.
But in that lower Manhattan area, we had a census of over 1,400 patients. And I
believe September 11, 2001 was on a Tuesday. By that Friday, our nurses had
made contact with every single one of those patients– every single one of those
patients. What has changed and what we have learned from this is that we, I
would say, have a much more robust emergency and disaster plan now than we
had then. And that emergency and disaster plan, I think while it always has been
an excellent one around how will we deliver face to face services to people, it has
not always involved thinking through well, what about the other ancillary services
that are essential to care delivery and if they are disrupted?
And so for example, we work in a much more collaborative way with the New
York City Office of Emergency Services then we ever have and the then we did
in the past. Because for example, at first, as I mentioned, we were excluded from
access to Lower Manhattan. Now instead of being excluded, New York City
sees our organization as a critical part of their emergency and disaster plan. So
there’s much more collaboration, I would say interagency collaboration, than
Emergency Preparedness and Disaster Response in Community Health Nursing
© 2016 Laureate Education, Inc. 2
there has been in the past. And I think the city is much more aware of the
contribution that an agency like ours can make in a disaster such as 9/11 or in an
overwhelming flood or in mass immunization for the H1N1 virus.
So I think there’s a much more robust plan that exists within our own
organization, but also exists in the city of which we are an integral part. We have
an emergency and disaster plan, we have exercises, mock exercises that we
conduct probably twice a year to quarterly. Before September 11, we had an
emergency and disaster plan but we didn’t conduct routine mock exercises to see
how would we respond, who would be in charge of communications, who would
be in charge of logistics.
So we’ve actually adopted what’s called the Incident Command System, which
really evolves out of firefighting science. And it’s a model for managing crises that
the New York City Fire Department uses and I think many large fire departments
around the country use where there’s an organizational structure that goes into
effect in a crisis that may be different from the typical organizational structure that
exists during the day to day operations that identifies particular roles that individuals
that have to be carried out in an emergency situation and designates several
individuals, primary and backup, who would take on those roles in an emergency.
So I think it’s just a very different kind of planning activity that we have engaged
in, both internally and with partners around the city since this particular incident.
For example, we’ve been working with the New York City Department of Health since
Katrina. There’s been a lot of look at what would happen in New York City if there
were a major flood and who are the people in the city who are at risk, who are
immobile, who would have to be evacuated and cannot do this on their own. And
they’ve come to us to help them to identify within our caseload because we
serve a lot of people in New York City. On any given day, our average daily
census is about 30,000 patients.
So we have a huge database of individuals and what their health problems are,
what their medications are so that we’ve been working much more collaboratively
with the city to identify who people at risk are for different kinds of terrorist or
other kinds of emergency situations that might occur in the city and how would
we respond to those in conjunction with them.
[MUSIC PLAYING]
FERNANDO GUERRA: Transporter, meta, supply of shipment that came from a
part of the developing world where some specimens were shipped to one of our
biosafety labs for facilities in San Antonio that do basic research. And some of
the organisms that you find in the developing world that potentially can cause
very serious and life-threatening illness in individuals. These biological
specimens were picked up at the airport and were being transported to the
Emergency Preparedness and Disaster Response in Community Health Nursing
© 2016 Laureate Education, Inc. 3
laboratory and when the driver got to the laboratory, the specimens were not in
the truck.
And so that became a real public health emergency because that happened to
be specimens that were thought to contain herpes B simian virus, which if it gets
into human hands is potentially lethal. So that required an immediate response
and the fact that it was on a holiday weekend added another layer of challenge.
So what I’m describing for you is there’s totally an anticipated incidence that a
the local health department has to certainly be prepared to deal with it. And of course
today, some of the very big challenges are those being prepared for pandemic flu
or for some of the natural disasters or man-made terroristic type of activities that
do require a level of constant training and expertise and certainly developing
the capacity for response.
[MUSIC PLAYING]
GEORGE T. DIFERNANDO, JR.: When I was the acting Commissioner of Health
in New Jersey, a few weeks after 9/11, as many people know, letters started
arriving at different media places in the United States, at a different newspaper
publisher in Florida, at television anchors and newspaper people in New York
City. And then finally, these letters went to different politicians in Washington.
Now, it turned out all these letters were being dropped in a post office box in
Princeton, New Jersey, and then transmit to a larger postal facility in Hamilton,
New Jersey, which is about five, 10 miles from where I was working as
Commissioner of Health.
And we didn’t know that right away, all we knew was where letters were arriving.
But as time went on, in September and then October of 2001, it became clear
that the letters were being processed at a large processing facility. And both
myself and other people at the New Jersey State Department of Health and
Senior Services went over to this processing facility. In this circumstance, I knew
something about occupational health, as did other people. We started treating
that facility, the Hamilton Post Office, as an occupational site, rather than a
terrorist site.
Now, as an occupational site, you look at the process, the work process. When
we started looking at the work process, we realized that the letters and the
different objects were going through these high-speed presses. It looked much
like pasta machines, where the letters will go in one end and get squeezed
almost like a tube of toothpaste. And it seemed that if there was any chance that
there was material that could be aerosolized, that material would be aerosolized.
We didn’t know that we weren’t absolutely sure, but we decided to close the
the facility as a precaution to do some sampling. We were in a situation where we
didn’t know if the building was safe or not, and so in that circumstance, I told the
postal service, the local and regional postal service, that I couldn’t vouch that that
Emergency Preparedness and Disaster Response in Community Health Nursing
© 2016 Laureate Education, Inc. 4
was a safe building from an occupational point of view. I understood that there
were implications of that for moving the mail and potentially security, but from an
occupational point of view I couldn’t stand next to them and tell the workers as
they walked in that they were walking into a safe work site.
Given that, they made the correct decision to keep the building closed and it
turned out that the building was closed for over a year and a half and then a
multimillion-dollar process had to occur to clean all the different pieces of that
building. In other parts of the United States, the buildings weren’t closed because
people convinced themselves for various reasons that, well, how could this be a
problem? They started thinking hypothetically instead of looking at the work
process and imagining what could have happened and how workers could be in
danger.
[MUSIC PLAYING]
Emergency Preparedness and Disaster Response in Community
Health Nursing
Additional Content Attribution
FOOTAGE:
September 11
9-11 World Trade Center Attack. (2001). [Video file]. Used by permission of
buyoutfootage.com. Retrieved from
http://www.buyoutfootage.com/pages/titles/bof_9-11.html#.V02bxfkrK71

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