Community Preparedness

The law enforcement agency, the city or county emergency management department, and the state public health department are responsible for coordinating efforts to assist people when a disaster happens. The American Red Cross may disperse personnel and supplies to assist with essential needs and medical care. If the state requests assistance, Homeland Security determines if the Federal Emergency Management Agency (FEMA) is to be called. If so, FEMA brings personnel and aid to the area. If a disaster is of major proportions, a Disaster Medical Assistance Team (DMAT) may be activated at the state or federal level. These units bring medical, paraprofessional, and support personnel along with medical equipment and supplies to sustain an operation for a minimum of 72 hours. The team provides triage (sorting out of casualties by priority of need for treatment), evacuation, primary health care, and assistance to local health care facilities that are overwhelmed. The emergency management team sets up a communications system, and the emergency medical services (EMS) personnel at the scene notify the emergency departments at the hospitals of the situation. With pagers, telephone trees, and instant computer alert messages, essential personnel are notified of a disaster or mass casualty (many-victims incident).

Community residents are instructed about what to do in the event that an earthquake, wildfire, hurricane, tornado, or flood occurs in their area.

Hospital Preparedness

The Joint Commission requires that hospitals have an emergency preparedness plan in place. There are guidelines for emergency preparedness by type of facility. Emergency department physicians undergo formal training for disaster events. Emergency department nurses are encouraged to obtain certification in emergency preparedness. Health care systems must self-evaluate surge capacity, which is defined as the maximum services that a facility can offer when every resource is mobilized (Barishansky & Langan, 2009); therefore the emergency plan should be tested with drills at least twice a year.

The emergency preparedness plan will identify who will be in charge and the chain of command for the facility. The designated communications officer is responsible for internal communication, such as keeping the staff informed, and for external communication, such as contacting other agencies for help, or reporting data about infection or chemical contamination that could have widespread effects (Rebmann, 2009). There will be a hospital incident commander (physician or administrator) who assumes responsibility for launching the emergency preparedness plan. This person’s role as commander is to view the entire situation, to bring in needed human and supply resources, and facilitate the flow of patients through the system. Usual hospital routine will be altered to accommodate care for high numbers of patients. Departmental roles will be changed. Physical therapy and other departments may close down usual operations and become the minor treatment area for the nonurgent patients. The concept of “reverse triage” or sending relatively stable patients home can be used to free up beds. Using an evidence-based computer model, researchers determined that any patient who had a 12% or less risk for an adverse event within the next 4 days could be discharged under disaster circumstances (Kelen et al., 2009).

A medical command physician will focus on determining the number, acuity, and medical needs of the casualties arriving from the scene of the disaster. This person will organize the emergency health care team response to the injured or ill patients. Specialists trained for the particular type of disaster will be called in to help as the need is foreseen. Decisions will be made about who is to be evacuated to a facility with a higher level of care.

A triage officer, usually a physician, with the assistance of triage nurses, will rapidly evaluate each patient at the hospital and send the patient to the appropriate area for immediate or eventual treatment. The emergency department supervisor or charge nurse collaborates with the medical command physician and triage officer to organize nursing and ancillary personnel to meet patient needs. A telephone tree will be activated to call in off-duty staff. In addition to these personnel, there will be a supply officer, communications officer, infection control officer, and public information officer. The public information officer will manage the media. Hospital staff, at all levels, will be called on to assist with whatever care is needed. Long-term care facilities may need to evacuate residents, or they may need to take in people from other facilities or the community.

Psychological Responses to Disaster

Any intense event results in an emotional response. Natural disasters or massive injuries from a man-made event have both physical and emotional effects. The phrase “they are in shock” is used to explain the emotional state of the victims following one of these events. Although emotions can trigger physical signs and symptoms, the condition is usually not life threatening unless the individual affected has a preexisting condition that puts her at risk.

Signs and symptoms of emotional shock include headaches, nausea, and chest pain. Preexisting medical conditions may worsen due to the stress. Remaining calm and seeing to immediate physical needs can reassure the victim that someone is in charge that has control over the situation. Severe emotional trauma, such as post-traumatic stress disorder, may take years of therapy to process.

Triage

Even though triage may have been done in the field, triage is performed again at the emergency care facility. Green-tagged patients usually comprise the greatest number in large-scale disasters. Patients need to be managed until they are able to be treated. If not managed, patients can become a health hazard by walking around with infection, radioactivity, or chemical contamination. A special bracelet with a disaster number may be applied to tagged patients.