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Emergency Preparedness

Marissa Krueger, SN

Zakaria Brema, SN

Elise Glos, SN

Venus Her, SN

Lydia Rosengren, SN

Emergency Preparedness

Emergency Preparedness is defined as "a coordinated, cyclical process of planning, implementation, evaluation, and learning which aims to increase the capability of society to prevent, protect against, respond to, and recover from any occurrence which presents a serious threat to the health of the community, or disrupts the health care system, or causes (or is more likely to cause) such numbers or types of casualties as to require special arrangments to be implemented by one or more health care organizations" (Boyd, et. al, 2014, p. 3)

Health Care Systems

Health Care Systems

In the event of a disaster, health care systems should be mindful of:

1. Mismatched Resources and Demands

2. Nature of the hazard

3. Various activites that need to be planned for and managed

(Boyd, et. al., 2014).

Other functions pertaining to the management of a disaster that can be impaired include:

-Communication, resources and assets, safety and security, staff responsibilities, utilities, and clinical and support activities

(Maryville University, n.d.)

Health Care Systems

" Emergency planing aims to increase the resistance and resilience of health-care supply and demand systems by implementing measures to prevent incidents, and preparing systems to respond to and recover from incidents that do occur" (Boyd, et. al, 2014, p. 5).

1. Mismatched Resources and Demands

-With an increase of demands, there could be a risk of a decrease in heath-care staff (ex: increased demands for health-care related to influenza pandemic but reduced staffing due to exposure and becoming infected)

-Typically disasters reduce the supply of resources and staffing = critical to be aware of and prepare for in the event of a disaster

2. Nature of the hazard

-understand nature of the hazard and what public is affected by the health emergency

-understand the necessary interventions specific to the management of the hazard (medications, care planning, type of personal protective equipment [PPE])

3. Various activites that need to be planned for and managed

-planning for the various implementations of the emergency plan, such as trainings on proper use of PPE's for chemical or decontaminiation equipment.

Be aware of available resources and capacity of the organization to better understand what is realistic to understake in a disaster.

(Boyd, et. al., 2014)

Pros and Cons to Implentation Changes

(Boyd, et. al., 2014)

PROs

-Increasing training on proper PPE use for specific hazards can increase protection for first-responders from harm from exposure

-An emergency plan can help to build a foundation to start with for an emergency

-Having an understanding of the level to which a hospital can function/withstand in a disaster can be used to know what is manageable or feasible in terms of supplies and capacities; can also help to identify needs for improvement

-Improvements can always be made to the plan based on tried-and-true interventions to increase quality of delivery of care

CONs

-Emergency plans are not fool-proof and may require alternatives in the moment to address an issue or improvements to be made post-disaster

-Capacities may not always be strictly followed dependent on the disaster

-Risk of harm to patient/provider safety with direct exposure to disaster

-Decreased communication amongst interdisciplinary team during high-stakes situations

-Risk for psychological trauma as a result of disaster and events that can take place during it

-Increased demands couples with reduction in staff due to sickness or burnout

Challenges between Levels of HealthCare Systems

As a nurse administering care in a disaster, they are likely to encounter challenges posed to the functionality of the Micro and Macro Systems in a disaster.

Therefore, through the process of analyzing the levels of the health care systems (micro/macro), it will increase awareness of potential conflicts that can arise and impact the collaboration between the two systems.

-An example can include a healthcare organization (macro level system) during a disaster and suffering from increased demands for resources, but unable to provide due to limited supplies and reduced staffing. The challenge posed to the macro system (healthcare organization) then impacts the delivery of care to the micro system (the patient). Due to the poor or limited delivery of care to the patient (micro level), it results in poorer health outcomes or worsening of current condition.

Strategies that can be utilized to address these challenges include:

-Attempts to surge capacities of organizations and available community resources in the event of a disaster

-Implementation of an Emergency Plan to utilize in specific periods of disaster to ensure the effectiveness in the delivery of care

-Continual facilitation of communication amongst interdisciplinary team

(Boyd, et. al., 2014)

Collaboration and Communication

Collaboration and Communication

Communication implications that organizations should consider are:

  • How will the information such as policy changes or changes in practice be conveyed to healthcare workers, patients, and others involved based on the emergency environment (e.g., global pandemic)

  • Will the workload increase drastically during emergencies; shortness of staff, burn out, limited space available to take care of patient, etc

  • How will communication in times of emergency affect collaboration between interdisciplinary teams and healthcare workers?

(Curtin, Richards, & Fortune, 2022)

Effective Risk Communication Method

Based on a systematic review on the public health emergency in Wuhan, China with the outbreak of COVID-19

What went wrong in Wuhan?

  • Public officials and government (gov't) took too long to make decisions
  • Gov't did not implemet a scientific approach to handling the COVID-19 outbreak (no consultation with epidemologic experts); deemed as a "public health issue"
  • Unclear communcation between gov't and public

What is effective risk communication?

"all related risk messages can be presented and shared to participants in a risk communication process openly and timely, aiming to rectify the knowledge gap between the originators of information and those receiving the information, and adjust the public’s behavior to cope with the risk proactively" (Zhang, Li & Chen, 2020, p. 1)

(Zhang, Li & Chen, 2020)

Effective Risk Communication Method

Utilizing Effective Risk Communication for Emergency preparededness in healthcare workers:

  • ALL parties invovled in the situation should be informed
  • Open accessibility to risk information
  • E.g., news broadcast, social media, newspaper, public annonucements from leaders
  • Communicating EARLY and OFTEN about risks
  • Avoiding ambiguous words such as "possbile", "probably", and "maybe"
  • Instead use numerical probability to convey the risk information/uncertainty in logical way

(Zhang, Li & Chen, 2020)

Communication through Social Media

Center for Disease and Control (CDC): approach to improving communication among public population & with healthcare workers (in relation to patients, coworkers, third parties, etc) during COVID-19 pandemic

Used Instagram to annonuce and educate individuals in times of globabl emergenices'

  • Images conveying risks and crisis information
  • Symptoms and transmission flyers
  • Personal preventative measures & mitigation
  • Social/common responsibility and empathy
  • Answering questions from the public (Q&A talks, live streams, etc)

Conveinence of technology to communicate information during times of quarantine

(Malik, Khan & Quan-Haase, 2021)

Communication Breakdown in Healthcare

Macrosystem: CDC News Announcement

Microsystem: Individuals on Social Media

Mesosystem: Healthcare Reinforcement

Share Mask Requirement on Social Media Platforms

Mandatory Mask Policy Passed

Hospital Implementation of Mandatory Mask

Provides risks and crisis information

Personal preventative measures & mitigation of spreading COVID-19

Nurses & other healthcare workers encouraging vaccination & social 6ft distancing until CDC uplifts mask requirements

Policy created to prevent and contain spread of COVID-19 amongst public population. Mandated for all public spaces including the healthcare facilities (e.g., hospitals, clinics)

Power &

Conflict

Power and Conflict

Impact on nurses: stress due to witnessing human suffering, risk of personal harm, intense worklads, life and death decisions, and separation from family (CDC, 2023).

Coping Mechanisms: Learn to identify burnout or stress, and practice self care techniques. Develop a buddy system to support and monitor each other' stress and workload (CDC, 2023). Organizations can develop disaster policies and provide resources such as therapy or childcare.

Power and Conflict Con't

Conflicting experiences: Disaster nursing is a new specialty, with few evaluation tools, limited availability of experts, and limited opportunites for training. Organizations should establish formation disaster nursing education, develop and implement teaching methods and curriculum content, evaluate disaster drill simulations, and develop undergraduate education and training courses (Al Harthi et al., 2020).

Power shifts in health system: These can occur due to high tension, high stress, and sometimes a lack of communication. To prevent this, leaders should prioritize clear and consistent communication as well as clearly define tasks for healthcare staff to promote preparedness (Mortensen et al., 2022).

Quality of Care

Quality of Care

During a global pandemic, access to care can be difficult due to risk of spreading or contracting viruses. However, this is why we have certain policies and procedures that help us prepare for these emergency situations. Widely throughout the coronavirus pandemic we used Telehealth for a lot of our appointments. Some physicians have said that utilizing telehealth decreases the quality of care because they are unable to obtain a full health history and cannot complete an extensive physical of their patient. (Lotstein et al., 2008)

Quality of Care - Continued

  • Medical Resources: Medical emergencies can occur suddenly, leaving healthcare facilities overwhelmed and unable to cope with a sudden influx of patients. During the COVID-19 pandemic, hospitals lacked resources and supplies to effectively care for the high number of patients in need. This lack of resources greatly impacts the quality of care provided by nurses.
  • Short Staffing: Malaria is a severe disease affecting sub-Saharan Africa, causing over 619,000 deaths in 2021, with Nigeria accounting for 31% of them. The country has a severe shortage of medical doctors, with only 3.95 doctors per 10,000 residents. The shortage of medical professionals in Nigeria is a significant contributor to the high Malaria death rate. In contrast, the US has sufficient medical personnel to handle epidemics like COVID-19, which was contained in three years, while Nigeria has been battling Malaria for over a century. The high mortality rate from Malaria in Nigeria is indicative of the quality of care patients are receiving.

(Dobaño, C., 2018),

(World Health Organization, 2023)

(World Health Organization, 2022)

References

References

Al Harthi, M., Al Thobaity, A., Al Ahmari, W., & Almalki, M. (2020). Challenges for Nurses in Disaster Management: A Scoping Review. Risk Management and Healthcare Policy, 13: 2627-2634. https://doi.org/10.2147/RMHP.S279513

Boyd, A., Chambers, N., French, S., Shaw, D., King, R., & Whitehead, A. (2014). Emergency planning and management in health care: priority research topics. Health systems (Basingstoke, England), 3(2), 83–92. https://doi.org/10.1057/hs.2013.15

Centers for Disease Control and Prevention. (2023). Emergency Responders: Tips for Taking Care of Yourself. Emergency Preparedness and Response. https://emergency.cdc.gov/coping/responders.asp

Curtin, M., Richards, H. L., & Fortune, D. G. (2022). Resilience among health care workers while working during a pandemic: A systematic review and meta synthesis of qualitative studies. Clinical psychology review, 95, 102173. https://doi.org/10.1016/j.cpr.2022.102173

Dobaño, C. (2018, November 14). 115 Years of Malaria in Africa: A Brief History and Future Outlook. ISGlobal. https://www.isglobal.org/-/115-years-of-malaria-in-africa-a-brief-history-and-future-outlook

Lotstein D, Seid M, Ricci K, Leuschner K, Margolis P, Lurie N; PREPARE for Pandemic Influenza. Using quality improvement methods to improve public health emergency preparedness: PREPARE for Pandemic Influenza. Health Aff (Millwood). 2008 Sep-Oct;27(5):w328-39. doi: 10.1377/hlthaff.27.5.w328. Epub 2008 Jul 15. PMID: 18628274.

Malik, A., Khan, M. L., & Quan-Haase, A. (2021). Public health agencies outreach through Instagram during the COVID-19 pandemic: Crisis and Emergency Risk Communication perspective. International journal of disaster risk reduction : IJDRR, 61, 102346. https://doi.org/10.1016/j.ijdrr.2021.102346

Maryville University (n.d.). Emergency operations plan: 6 key elements checklist for hospitals. Maryville University Master’s in Health Administration. https://online.maryville.edu/blog/emergency-operations-plan/#:~:text=According%20to%20The%20Joint%20Commission's,and%20clinical%20and%20support%20activities.

Mortensen, C. B., Zachodnik, J., Caspersen, S. F., & Geisler, A. (2022). Healthcare Professionals’ Experiences During the Initial Stage of the COVID-19 Pandemic in the Intensive Care Unit: A Qualitative Study. Intensive and Critical Care Nursing, 68, 103130.

World Health Organization [WHO]. (2023). Medical doctors (per 10,000 population). Global Health Observatory data repository. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/medical-doctors-(per-10-000-population)

World Health Organization. (2022, April 21). Malaria. Fact sheet. https://www.who.int/news-room/fact-sheets/detail/malaria

Zhang, L., Li, H., & Chen, K. (2020). Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China. Healthcare (Basel, Switzerland), 8(1), 64. https://doi.org/10.3390/healthcare8010064

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