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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)
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.)
" 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)
(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
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)
Communication implications that organizations should consider are:
(Curtin, Richards, & Fortune, 2022)
Based on a systematic review on the public health emergency in Wuhan, China with the outbreak of COVID-19
What went wrong in Wuhan?
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)
Utilizing Effective Risk Communication for Emergency preparededness in healthcare workers:
(Zhang, Li & Chen, 2020)
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'
Conveinence of technology to communicate information during times of quarantine
(Malik, Khan & Quan-Haase, 2021)
Macrosystem: CDC News Announcement
Microsystem: Individuals on Social Media
Mesosystem: Healthcare Reinforcement
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)
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.
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).
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)
(Dobaño, C., 2018),
(World Health Organization, 2023)
(World Health Organization, 2022)
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