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Nursing Management:
doi: 10.1097/01.NUMA.0000432219.63886.f8
Feature: CE Connection

Will you be ready when disaster strikes?

Gardner, Candace BSN, RN, PCCN; Frazier, Erin BSN, RN, PCCN

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Author Information

At Texas Health Harris Methodist Hospital Fort Worth (Tex.), Candace Gardner is a nurse manager and Erin Frazier is a nursing supervisor.

The authors and planners have disclosed that they have no financial relationships related to this article.

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Is your facility prepared to handle a disaster? Over the past 10 years, disaster preparedness awareness has increased, promoting the development of emergency operations plans for healthcare.1 As nurse managers, we have a responsibility to ensure that our staff members receive the proper education and training required to be prepared for disasters and are able to respond appropriately when a disaster strikes.

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What constitutes a disaster?

According to the Centre for Research on Epidemiology of Disasters, a disaster is “a situation or event which overwhelms local capacity, necessitating a request to the national or international level for external assistance; an unforeseen and often sudden event that causes great damage, destruction, and human suffering.”2 The World Health Organization defines a disaster as “a serious disruption of the functioning of a community or a society causing widespread human, material, economic, or environmental losses, which exceed the ability of the affected community or society to cope using its own resources.”3

Although the definitions may vary, the basic concept remains the same: A disaster occurs without warning and has the potential to produce deleterious effects for people in the surrounding areas. Furthermore, disasters are notorious for impacting healthcare providers' ability to deliver clinical care to disaster victims. And at an institutional level, the organization is at risk for infrastructure damage or even loss.

To understand the term disaster is to understand its cyclical nature. The disaster cycle involves a form of preparedness for the disaster, the actual disaster itself, the response to the disaster, and, finally, the recovery after the disaster.4 However, no amount of training, education, or preparedness can prevent a disaster from occurring, much less recurring.

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Regulatory and legislative requirements

Disaster plans for acute care facilities are regulated and mandated by The Joint Commission and the federal government. The Joint Commission has developed emergency management guidelines to facilitate disaster planning in acute care facilities, which require annual evaluation of a facility's emergency management planning activities.5 This entails evaluating disaster risk and the potential effects a disaster may have within the community and the organization.5

The Joint Commission further requires acute care facilities to evaluate the effectiveness of their emergency operations plan, also known as a disaster plan. This evaluation is accomplished through twice-yearly exercises.5 For acute care facilities with EDs, one of these emergency response exercises entails the ED receiving simulated patients for triaging.5 The second exercise must involve the community.5 These exercises vary based on potential disasters specific to the facility's geographic location. The exercises may include simulations in a lab setting, unit-specific drills using life-sized mannequins, or hospital-wide exercises with medical tents for simulated patient volumes and injuries.

On March 1, 2004, the National Incident Management System (NIMS) was developed as a guide to emergency management planning for all types of organizations.6 The NIMS provides a written framework for disaster preparedness and offers online training for healthcare professionals. Additional resources include the Hospital Incident Command System (HICS) guidelines, which lay the groundwork for emergency preparedness training in the acute care setting, regardless of facility size.7 In response to recent disasters, the Federal Emergency Management Agency developed the National Preparedness Goal, which was designed to assist communities with disaster and emergency preparedness.8

Hospitals should apply the principles of The Joint Commission emergency management standards and the HICS guidelines to develop their own emergency operations plan designed to meet the needs of the acute care facility, its healthcare workers, and the community that it serves.

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Planning for the worst

Do you know your hospital's disaster plan? Do you know how to locate it? It's evident that acute care facilities are integral in the event of a disaster. Healthcare workers require adequate training in disaster preparedness and must know their role in the event of a disaster. The intent of a disaster plan for an acute care facility is to protect healthcare workers while sustaining adequate patient care and meeting the needs of those in the community affected by the disaster. (See Creating and maintaining a disaster plan.)

A crucial aspect of disaster preparedness is the establishment of a command center and the designation of authority during a disaster. According to the NIMS, an incident command system can assist with disaster management.6 The emergency operations plan identifies the individuals who are to be the leaders of authority during a disaster event.5 This document also includes the predetermined area designated as the command center. An alternate command center location should be in the emergency operations plan in the event that the primary location is unavailable. The command center should include multiple means of communication, as well as an emergency power source. Led by the incident commander, who makes the final decision on actions regarding facility evacuations and use of outside resources, the command center provides two-way communication between frontline staff and command center leaders.5

During a disaster, acute care facilities must anticipate a surge in patient volumes. (See Steps to take during a disaster.) The ED plays a key role because it will receive these surge volumes. Make sure your nursing staff members have a clear understanding that their role is to quickly triage and assess patients, with a goal of discharge. Inpatient units should prepare to receive an influx of patients who may not have an actual room, which means patients may be housed in hallways and visitor areas.

In the event of a disaster, reach out to clinical and nonclinical staff to identify those who can immediately report to work. Know who your community partners are at the local, state, and federal levels. Community volunteers are critical during a disaster. Organizations should consider utilizing retired medical personnel or other community volunteers; although they may or may not be licensed, they do have an understanding of healthcare services.9 Other community resources to consider include the American Red Cross and the Medical Reserve Corps, both of which utilize volunteers with backgrounds in medical services.10,11

Employees should be prepared to anticipate the level of response required for different types of disasters. For example, the levels of response and the roles of healthcare workers during a tornado are different than those during an internal or external fire. Through frequent rehearsal of the different roles involved in emergency response exercises, healthcare workers will be better prepared to respond to the needs of their coworkers and the victims involved in potential natural or unforeseen disasters.12

Healthcare workers must also know when to evacuate horizontally, laterally, or vertically. In the event of an evacuation, healthcare workers, volunteers, and visitors may assist with the evacuation and should only be assigned tasks appropriate to their capabilities. The incident command center will determine which type of evacuation is needed based on the emergent circumstances.5

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Is your staff prepared?

At the forefront of any disaster event, department personnel are responsible for maintaining patient safety. (See Ensuring staff disaster preparedness competencies.) First, assess and identify the types of disasters that pose a threat to your facility and then develop your emergency operations and education plan accordingly. After the disaster plan is developed, staff members can be aligned with their roles and responsibilities during a disaster. Ensure that your staff members understand the situations they could be in and the barriers they must overcome if their response is needed.

Do your staff members know how to locate your facility's disaster plan? Do they know their specific role during a disaster? An important aspect of any disaster plan is for each individual to have a basic understanding of his or her role.13 Knowing where and how to access the disaster plan is critical knowledge your staff needs before a real disaster occurs. Consider staff members' ability to navigate your facility's intranet to retrieve disaster materials, keep your department manual up to date with the latest information, and make sure your charge nurse is knowledgeable about the disaster plan.

Although every disaster has unique characteristics, the basics for staff competencies remain unchanged. First and foremost, staff members must be able to locate, use, and apply the emergency operations plan. This means that, in the event of a disaster, the charge nurse is able to readily access, communicate, and implement the plan. Secondly, staff members must be able to effectively communicate their designated roles and responsibilities during a disaster event. Staff members must also actively participate in disaster drills. This includes demonstrating the ability to effectively and appropriately use any evacuation- or disaster-specific equipment.

Evaluating and determining staff members' levels of competence allows the acute care facility disaster coordinator to develop education and prepare basic competencies for disaster preparedness. To demonstrate these competencies, active participation by staff is necessary and expected.14 Staff members who are involved in disaster response exercises can make suggestions regarding the ease of use of evacuation equipment. Through these exercises, knowledge gaps can also be identified, allowing for future education and training specific to those areas. Engaging department or unit champions is important for the overall success of hands-on training.

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Barriers to preparedness

One of the first barriers an organization may encounter is the lack of a formalized disaster plan. (See Overcoming organizational and staff preparedness barriers.) To combat this barrier, become familiar with federal and regulatory requirements for disaster preparedness. The Joint Commission states that all leaders of the organization should have input when developing their facility's emergency operations plan.5 Another barrier may be the lack of fiscal resources to purchase evacuation training materials, which are crucial for staff competency requirements and emergency preparedness, or allocated dollars for a disaster planner position. If the budget doesn't allow for a formalized position, who'll fill this role? The Joint Commission requires hospitals to designate a staff member to monitor and evaluate the effectiveness of emergency preparedness exercises.5

Barriers managers are likely to encounter are staff engagement, knowledge gaps, and lack of participation in disaster exercises. Understanding staff barriers is essential for buy-in and participation in such training activities. If our staff members let their personal barriers interfere with disaster preparedness training, how will they understand their roles in the event of an actual disaster? Lack of disaster preparedness training can lead to a poor response in the event of a disaster due to lack of staff members' confidence in their responsibilities. A major factor in the willingness to report to work in the event of a disaster, as well as receiving proper training, has been identified as personal commitments and responsibilities, including taking care of family members.15

How can you overcome these barriers? Assess staff members' capability and understanding of their individual roles in the event of a disaster. Ensure that staff members are active participants in departmental, divisional, and hospital disaster preparedness exercises. Work with your hospital disaster planner to further advance staff members' knowledge and skills in utilizing disaster-specific evacuation equipment. Although direct care nurses are competent with the equipment they utilize in their daily practice, they may need additional hands-on training through disaster drills.14

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Poised and ready

Much like the nursing process, healthcare leaders must assess, diagnose, implement, evaluate, and plan for disasters. There's an obvious and required need for healthcare leaders to know the impact of disasters, in addition to appropriate staff management in the event of a disaster. Identify potential barriers to disaster preparedness training and education, and provide the materials and resources needed to ensure adequate training for your staff. Keeping your facility's disaster plan readily available and easily accessible is crucial to the success of your staff's reaction in the event of a disaster. By knowing your facility's disaster plan and utilizing tools to engage staff in its implementation, you'll have working knowledge of how to function if a disaster occurs.

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Creating and maintaining a disaster plan

  • Know which disasters are relevant to your situation and area.
  • Know and review federal and other disaster preparedness guidelines.
  • Periodically review your facility's emergency operations plan.
  • Review and update your facility's disaster preparedness policy.
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Steps to take during a disaster

  • Maintain the safety of yourself, staff members, and patients.
  • Obtain access to your facility's emergency operations plan.
  • Follow the guidelines set forth in the emergency operations plan.
  • Communicate with the established command center.
  • Activate your unit responder plan to identify staff members who are able to report to work.
  • Prepare for surge volumes as listed in the emergency operations plan.
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Ensuring staff disaster preparedness competencies

  • Assess staff baseline knowledge of disaster preparedness. Does each staff member know his or her role?
  • Provide disaster preparedness training with emergency and evacuation equipment.
  • Reassess with appropriate training to obtain staff retention of disaster preparedness knowledge.
  • Provide ongoing training opportunities based on federal guidelines and identified needs.
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Overcoming organizational and staff preparedness barriers

  • Establish a position or designate a staff member as your safety coordinator.
  • Develop disaster preparedness education and training relevant to potential disasters.
  • Establish relationships with surrounding entities, including acute care facilities, skilled nursing facilities, and the city government (local police, firefighters, EMS).
  • Partner with local community resources (American Red Cross, faith-based organizations).
  • Clearly designate individual roles.
  • Provide a minimum of two disaster preparedness drills per year.
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REFERENCES

1. Veenema TG. Disaster preparedness 10 years after 9/11. Am J Nurs. 2011; 111:(9):7.

2. Centre for Research on the Epidemiology of Disasters. The international disaster database. http://www.emdat.be/glossary/9#term81.

3. World Health Organization. Definitions: emergencies. http://www.who.int/hac/about/definitions/en/index.html.

4. Godschalk D. Breaking the disaster cycle: future directions in natural hazard mitigation. http://training.fema.gov/EMIWeb/downloads/breakingdisastercycle/Session%201%20Revised-ppt.pdf.

5. The Joint Commission. 2013 Comprehensive Accreditation Manual for Hospitals. Oak Brook, IL: Joint Commission Resources; 2012.

6. U.S. Department of Homeland Security. National incident management system. http://www.dhs.gov/xlibrary/assets/foia/mgmt_directive_9500_national_incident_management_system_integration_center.pdf.

7. Kaiser Permanente Washington Hospital Center. Hospital incident command system guidebook. http://www.emsa.ca.gov/HICS/files/Guidebook_glossary.pdf.

8. Federal Emergency Management Agency. National preparedness goal. http://www.fema.gov/national-preparedness-goal.

9. Federal Emergency Management Agency. Managing spontaneous volunteers in times of disaster: the synergy of structure and good intentions. http://www.fema.gov/pdf/donations/ManagingSpontaneousVolunteers.pdf.

10. Red Cross. Mission, vision, and fundamental principles. http://www.redcross.org/about-us/mission.

11. Medical Reserve Corps. About the Medical Reserve Corps. https://www.medicalreservecorps.gov/HomePage.

12. Federal Financial Institutions Examinations Council. Lessons learned from hurricane Katrina: preparing your institution for a catastrophic event. http://www.ffiec.gov/katrina_lessons.htm.

13. Wisniewski R, Dennik-Champion G, Peltier JW. Emergency preparedness competencies: assessing nurses' educational needs. J Nurs Adm. 2004; 34:(10):475–480.

14. Kirwan MM. Disaster planning: are you ready. Nursing made Incredibly Easy!. 2011; 9:(3):18–24.

15. Ogedegbe C, Nyirenda T, DelMoro G, Yamin E, Feldman J. Health care workers and disaster preparedness: barriers to and facilitators of willingness to respond. Int J Emerg Med. 2012; 5:(1):29.

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