Disaster Nursing and Emergency Preparedness


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"The third edition of Disaster Nursing and Emergency Preparedness was confronted with the daunting task of both summarizing the many important new findings that have now become available through extensive research and the experience of public health practitioners and yet maintain the convenience and user-friendliness of the first two editions. Dr. Veenema has succeeded in accomplishing this magnificently. The third edition has almost double the number of pages compared with the first edition, including a much stronger and expanded clinical management section to address clinical situations not frequently encountered by nurses...The reader is provided with substantially greater coverage of the needs of children and adolescents following the recommendations of the National Commission on Children and Disasters (2010)...[This book] will continue to serve as both a timely and comprehensive text for this nation's 2.7 million nurses and for educating the next generation of nursing professionals."

From the Foreword by Eric K. Noji, MD, MPH
Centers for Disease Control and Prevention (Ret.)
Washington, DC

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Disaster Nursing and Emergency Preparedness

  2. 2. ii THIRD EDITION Tener Goodwin Veenema, PhD, MPH, MS, RN, FAAN, is an internationally recognized expert in disaster response and emergency health services, and in public health emergency preparedness. As President and Chief Executive Officer of the Tener Consulting Group, LLC, Dr. Veenema has served as senior consultant to many agencies of the United States Government, including the Department of Health and Human Services, Department of Homeland Security, Department of Veterans Affairs, and most recently FEMA and the Administration for Children and Families. She has received numerous awards and research grants for her work, and is an elected Fellow in both the National Academies of Practice and the American Academy of Nursing. Veenema is a member of the National American Red Cross Scientific Advisory Board, Disaster and Mental Health Services subcommittee, and has been a volunteer American Red Cross nurse for many years. As Senior Consultant for Disaster Preparedness to the Office of Human Services Emergency Preparedness and Response, Administration for Children and Families at the U.S. Department of Health and Human Services, Dr. Veenema was advisor to the FEMA/ACF Disaster Case Management Program from 2009 to 2012 and lead author for the Interim Report of the National Commission on Children and Disasters (2010).While at the University of Rochester, Dr. Veenema developed the cur- riculum for a 30-credit master’s program entitled “Leadership in Health Care Systems: Disaster Response and Emergency Management,” the first program of its kind in the country to be offered at a school of nursing. A highly successful author and editor, Dr. Veenema has published textbooks, handbooks, deci- sion support software and multiple articles on emergency nursing and disaster preparedness. She is the author and developer of two nationally award winning Disaster e-Learning Courses, Red Cross ReadyRN Disaster and Emergency Preparedness for Health Services (American Red Cross, 2007) and ReadyRN (Elsevier, MC Strategies, 2008). These interactive, e-learning programs have trained thousands of nurses and other disaster health services responders in caring for victims of disasters, terrorist events, and public health emergencies. A highly motivated, energetic self-directed leader with a high degree of creativity and innovation, Dr. Veenema is in high demand as a speaker and her decision-support software and information technology applications for disaster response have been presented at conferences around the globe. Dr. Veenema received her Bachelor of Science degree in Nursing from Columbia University in 1980, a Master of Science in Nursing Administration (1992), post-Master’s degree in the Care of Children and Families (1993) from the University of Rochester School of Nursing, and a Master’s in Public Health (1999) and PhD in Health Services Research and Policy (2001) from the University of Rochester School of Medicine and Dentistry. A nationally certified Pediatric Nurse Practitioner, Dr. Veenema was the recipient of the 2010 Distinguished Alumni Leadership Award from her high school alma mater Suffield Academy, in Suffield, Connecticut.Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd ii 8/7/2012 10:27:41 PM
  4. 4. Copyright © 2013 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, info@copyright.com or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Allan Graubard Composition: Newgen Imaging ISBN: 978-0-8261-0864-7 E-book ISBN: 978-0-8261-0865-4 Instructors Manual ISBN: 9780826169723 The Instructors Manual is available on request from textbook@springerpub.com 12 13 14 15/ 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research, specific institutional policies, and current drug references before performing any clinical procedure or administering any drug. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this publication and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate. Note: Government websites are updated frequently. The reader is advised to access the agency’s main page and use the site’s internal search engine to locate desired information. Library of Congress Cataloging-in-Publication Data Disaster nursing and emergency preparedness for chemical, biological, and radiological terrorism and other hazards / Tener Goodwin Veenema, editor. — 3rd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8261-0864-7 — ISBN 978-0-8261-0865-4 (E-book) I. Veenema, Tener Goodwin. [DNLM: 1. Disasters. 2. Emergencies—nursing. 3. Disaster Planning. 4. Terrorism. WY 154.2] 616.02’5—dc23 2012016938 Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036-8002s Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 Email: sales@springerpub.com Printed in the United States of America by Bang Printing.Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd iv 8/7/2012 10:27:42 PM
  5. 5. Our world is not safe. Fraught with peril, it continues to be a dangerous place in which to live. And yet we know that our children need safe homes, safe schools, and safe communities to live in if they are to grow to be healthy, happy, and secure adults. They are counting on us to be there for them—no matter what the circumstances. They are counting on us to provide love, protection, and a safe harbor in the storm. They are counting on us to be prepared. They are counting on us to rescue them when they need rescuing. This textbook is dedicated to our nation’s children—four in particular. To Kyle, Kendall, Blair, and Ryne—you are everything to me. Always know how much I love you and how proud I am of you. Know that no matter how far away life takes you, home is always a safe harbor. And know that I tried to make the world a safer place.Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd v 8/7/2012 10:27:42 PM
  6. 6. Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd vi 8/7/2012 10:27:42 PM
  7. 7. CONTRIBUTORS vii CONTRIBUTORS Gary Ackerman, MA Frederick M. Burkle, Jr., MD, MPH, Director of Special Projects DTM, FAAP, FACEP START Projects Professor, Senior Fellow and Scientist University of Maryland Harvard Humanitarian Initiative College Park, MD Harvard School of Public Health Cambridge, MA Senior International Public Policy Scholar Michael Beach, DNP, ACNP-BC, PNP Woodrow Wilson International Center for Scholars Assistant Professor Washington, DC University of Pittsburgh School of Nursing Senior Associate Faculty and Research Scientist Pittsburgh, PA Center for Refugee and Disaster Response Departments of International Health and Emergency Medicine John G. Benitez, MD, MPH, FAACT, FACMT, Bloomberg School of Public Health FACPM, FAAEM Johns Hopkins University Medical Institutions Associate Professor of Medicine Baltimore, MD (Medical Toxicology) Vanderbilt University Kathleen Capitulo, DNSc, RN, FAAN, VHA-CM Managing Director Chief Nurse Executive, James J. Peters VA Medical Tennessee Poison Center Center, Bronx, NY Nashville, TN Executive Director, Transcultural Nursing Leadership Institute Professor, Wenzhou Medical College, Wenzhou, China Professor, Mount Sinai School of Medicine Lisa Marie Bernardo, PhD, RN, MPH Department of Preventive Medicine, Adjunct Associate Professor Associate Professor University of Pittsburgh School of Nursing Case Western Reserve University Pittsburgh, PA Cleveland, OH Thomas Chandler, PhD Kelly Betts, MSN, RN Associate Research Scientist Clinical Assistant Professor The National Center for Disaster Preparedness University of Arkansas for Medical Sciences Adjunct Assistant Professor, Teachers College College of Nursing Columbia University Mailman School of Public Health Little Rock, AR New York, NYVeenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd vii 8/7/2012 10:27:42 PM
  8. 8. viii CONTRIBUTORS Eric Croddy, MA Rebecca Hansen, MSW Senior Research Associate EAD & Associates, LLC Pacific Command Inclusive Emergency Management Consultants Honolulu, HI New York, NY Valerie Cole, PhD Kevin D. Hart, JD, PhD, MPH Disaster Mental Health Independent Consultant American Red Cross Brunswick, ME Washington, DC Debbie Cooley Huff, MNSc, RN Jeremy T. Cushman, MD, MS, EMT-P, FACEP University of Arkansas for Medical Sciences Assistant Professor College of Nursing Department of Emergency Medicine Little Rock, AR University of Rochester Medical Director, City of Rochester and County of Joy Jennings, MSN, RN, CNE Monroe Clinical Assistant Professor Rochester, NY University of Arkansas for Medical Sciences College of Nursing Kevin Davies, MBE, RRC, TD PhD, MA, RN, PGCE Little Rock, AR Professor of Nursing and Disaster Healthcare Faculty of Health, Sport and Science Andrew Karam, PhD, CHP University of Glamorgan Karam Consulting Glyntaff, Pontypridd New York, NY South Wales, UK Ziad N. Kazzi, MD, FAAEM Elizabeth A. Davis, JD, EdM Assistant Professor Director Medical Toxicologist EAD & Associates, LLC Department of Emergency Medicine Inclusive Emergency Management Consultants University of Alabama New York, NY Birmingham, AL Jane Kushma, PhD Pat Deeny, RN, RNT, BSc (Hons) Nurs Ad Dip Ed Associate Professor Senior Lecturer in Nursing Institute for Emergency Preparedness University of Ulster, Magee Campus Jacksonville State University Derry-Londonderry, Northern Ireland Jacksonville, AL Dona M. Dorman, MNSc, RN, RNP Linda Young Landesman, DrPH, MSW, ACSW, Clinical Assistant Professor LCSW, BCD University of Arkansas for Medical Sciences NYC Health and Hospitals Corporation College of Nursing New York, NY Little Rock, AR Roberta Proffitt Lavin, PhD, APRN-BC Shannon Finley, MSN, RN Chair and Professor of Nursing and Health Clinical Instructor Clarke University University of Arkansas for Medical Sciences Dubuque, IA College of Nursing Little Rock, AR Christopher Lentz, MD, FACS, FCCM Medical Director, Regional Burn Center Kristine M. Gebbie, DrPH, RN, FAAN Associate Professor of Surgery and Pediatrics Retired Dean and Professor Emeritus University of New Mexico Health Sciences Center Hunter College School of Nursing Albuquerque, NM New York, NYVeenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd viii 8/7/2012 10:27:42 PM
  9. 9. CONTRIBUTORS ix Karen L. Levin, MPH, MCHES, RN Deborah J. Persell, PhD Director, Columbia Regional Learning Center Associate Professor Associate Director, Planning and Response Coordinator for Disaster Nursing Preparedness The National Center for Disaster Preparedness Education Columbia University Mailman School of Public Health College of Nursing and Health Professions New York, NY Arkansas State University Jonesboro, AR David Markenson, MD, MBA, FAAP, FACEP Medical Director Brenda Phillips, PhD Disaster Medicine and Regional Emergency Services Department of Political Science Westchester Medical Center College of Arts and Sciences Professor of Pediatrics Oklahoma State University Maria Fareri Children’s Hospital Tulsa, OK New York Medical College Director, Center for Disaster Medicine David C. Pigott, MD, FACEP Professor of Clinical Public Health Residency Program Director School of Health Sciences and Practice and Institute of Associate Professor and Vice Chair for Education Public Health Department of Emergency Medicine New York Medical College University of Alabama at Birmingham Valhalla, NY Birmingham, AL Elizabeth C. Meeker, PsyD Office of Mental Health Kathleen Coyne Plum, PhD, RN, NPP Monroe County Department of Human Services Director, Office of Mental Health Rochester, NY Monroe County Department of Human Services Adjunct Associate Professor Gary W. Milligan, MSN, MSHA University of Rochester School of Nursing Instructor Rochester, NY University of Alabama School of Nursing University of Alabama at Birmingham Robbie Preppas, CNM, MN, NP, JD Birmingham, AL Adjunct Professor UCLA School of Nursing Los Angeles, CA Brigitte L. Nacos, PhD Co-Chairperson, Disaster Preparedness Caucus Department of Political Science American College of Nursing Columbia University Consultant, CDC Pandemic Flu Planning New York, NY Member Disaster Preparedness Medical Team Silver Spring, MD Sarah D. Nafziger, MD Assistant Professor of Emergency Medicine Brooke Primomo, MS, RN University of Alabama at Birmingham Burn Program Manager Birmingham, AL University of Rochester/Strong Memorial Hospital Rochester, NY Lori Peek, PhD Associate Professor Erica Rihl Pryor, PhD, RN Department of Sociology Co-Director Associate Professor and PhD Program Coordinator Center for Disaster and Risk Analysis University of Alabama School of Nursing Colorado State University Birmingham, AL Fort Collins, COVeenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd ix 8/7/2012 10:27:43 PM
  10. 10. x CONTRIBUTORS Kristine Qureshi, DNSc, CEN, RN Juliana Sadovich, PhD, RN Associate Professor Adjunct Professor School of Nursing and Dental Hygiene National Center for Emergency Preparedness University of Hawaii at Manoa Vanderbilt University Honolulu, HI Nashville, TN Adam B. Rains, MSc Cheryl K. Schmidt, PhD, RN, CNE, ANEF Lead Analyst/Proprietor Associate Professor Rains Analytics LLC College of Nursing Rochester, NY University of Arkansas for Medical Sciences Little Rock, AR Joy Reed, EdD, RN, FAAN Head, Public Health Nursing Division of Public Health Manish N. Shah, MD, MPH, FACEP North Carolina Department of Health and Human Associate Professor Services Department of Emergency Medicine Raleigh, NC Department of Community and Preventive Medicine University of Rochester Dixie Reid, PA Rochester, NY Physician Assistant Trauma/Burn/Emergency Surgery Capt. Lynn A. Slepski, PhD, RN, CCNS University of New Mexico Health Sciences Center United States Public Health Service Albuquerque, NM Senior Public Health Advisor Office of the Secretary of Transportation Lisa Rettenmeier, MSN, RN Washington, DC Instructor, Nursing/Health Clarke University Joy Spellman, RN, MS Dubuque, IA Director, Center for Public Health Preparedness Burlington County College Susan Ritchie, MN, RN Mt. Laurel, NJ Clinical Assistant Professor University of Arkansas for Medical Sciences Linda Spencer, PhD, MPH, RN College of Nursing Coordinator, Public Health Nursing Leadership Program Little Rock, AR Emory University Atlanta, GA Lou Romig, MD, FAAP, FACEP Pediatric Emergency Medicine Susan Speraw, PhD, RN West Kendall Baptist Hospital Associate Professor Pediatric Medical Advisor, Miami Dade Fire Rescue Coordinator, Global Disaster Nursing and Department Interdisciplinary Certificate Graduate Programs Medical Director for Pediatrics, National Association of University of Tennessee College of Nursing EMTs Knoxville, TN Team Medical Director, FL-5 Disaster Medical Assistance Team, DOH/ASPR Sharon A. R. Stanley, PhD, RN, RS Miami, FL Chief Nurse American Red Cross Tara L. Sacco, MS, RN, CCRN Washington, DC Clinical Nurse Specialist Kessler Family Burn/Trauma Intensive Care Unit Susan Strasser, PhD, MPH, PNP-BC, FAAN NeuroMedicine Intensive Care Unit Country Director University of Rochester Medical Center Elizabeth Glaser Pediatric AIDS Foundation Rochester, NY Lusaka, ZambiaVeenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd x 8/7/2012 10:27:43 PM
  11. 11. CONTRIBUTORS xi Susan Sullivan, MS, RN Colleen Woolsey, PhD, ARNP, MSN Public Health Nursing Consultant Stanislaus County Health Services Agency Public Health Regional Surveillance Team 4 Modesto, CA School of Medicine/Division of Infectious Diseases University of North Carolina at Chapel Hill Dianne Yeater, MS, RN Chapel Hill, NC Director for Disaster Health Services American Red Cross Devin Terry, ACNS-BC, RN Washington, DC Advanced Practice Partner for Ambulatory Services University of Arkansas for Medical Sciences Medical Center Little Rock, AR LCDR Jonathan D. White, PhD, LCSW-C Program Analyst/Team Lead for Strategic Partnerships and Community Resilience Administration for Children and Families Office of Human Services Emergency Preparedness and Response Washington, DCVeenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xi 8/7/2012 10:27:43 PM
  12. 12. Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xii 8/7/2012 10:27:43 PM
  13. 13. EDITOR xiii CONTENTS Foreword Ann R. Knebel DNSC, RN, FAAN xxv Federal Preparedness Planning and Emergency Response 23 National Response Framework 25 Foreword Eric K. Noji, MD, MPH xxvii The NRF as It Relates to the NIMS 25 The NRF and a Local Event 28 Foreword Loretta C. Ford, RN, PNP EdD , xxix Example: Use of the NRF in Responding to a Catastrophic Event 28 Foreword Susan B. Hassmiller, PhD, RN, FAAN xxx Implementation of the NRF 29 Roles and Responsibilities 30 Preface xxxi DHS (www.dhs.gov) 31 HHS (www.hhs.gov) 31 Acknowledgments xxxv DOD (www.defense.gov) 31 Other Departments and Agencies 31 ESF8: Public Health and I DISASTER PREPAREDNESS Medical Services 31 Federal Definition of a Disaster Condition 32 1. Essentials of Disaster Planning 1 NRF Considerations 32 Federal Medical Response Resources 33 Tener Goodwin Veenema and Colleen Woolsey National Disaster Medical System 33 Chapter Overview 2 The USPHS (http://www.usphs.gov) 34 Introduction 2 Civilian Volunteers 35 Definition and Classification of Disasters 3 Federal Medical Stations (FMS) 36 Declaration of a Disaster 4 Medical Response Actions 36 Health Effects of Disasters 5 Assessment of Health/Medical Needs 36 The Disaster Continuum 6 Health Surveillance 36 Disaster Planning 7 Medical Care Personnel 36 Types of Disaster Planning 8 Health/Medical Equipment and Supplies 37 Patient Evacuation 37 Challenges to Disaster Planning 8 In-Hospital Care 37 Hazard Identification, Vulnerability Analysis, and Risk Food/Drug/Medical Device Safety 37 Assessment 10 Worker Health/Safety 37 Capacity to Respond 12 Radiological/Chemical/Biological Hazards Consultation 37 Core Preparedness Activities 13 Mental Health Care 37 Evaluation of a Disaster Plan 14 Public Health Information 37 Situations Suggestive of an Increased Need for Planning 15 Vector Control 37 Megacities 15 Potable Water/Waste Water and Solid Waste Disposal 37 Disasters Within Hospitals 15 Victim Identification/Mortuary Services 38 Bioterrorism/Pandemic Disease 16 Veterinary Services 38 Hazardous Materials Disaster Planning 16 Challenges for U.S. Disaster Health Systems 38 Professional Nursing Mandate 17 Increased Risk 38 Summary 18 Limited Resources 38 Study Questions 18 Workforce Management 38 Internet Activities 19 A Blueprint for the Future for Disaster Nursing 38 Leadership 38 Roles and Functions 39 2. Leadership and Coordination Policy Development 39 in Disaster Health Care Systems: the U.S. National Public Health 39 Surveillance 40 Response Framework 21 Quality Care 40 Lynn A. Slepski, Roberta Proffitt Lavin, and Crisis Standards of Care for Use in Disaster Situations 40 Tener Goodwin Veenema Evidence-Based Practice 40 Education 40 Chapter Overview 22 Critical Thinking Skills 41 Introduction 22 Collaboration 41Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xiii 8/7/2012 10:27:44 PM
  14. 14. xiv CONTENTS Communication 41 Communication and Information Opportunities 41 Technology Issues 76 Summary 41 Hospital-Based Decontamination and Pediatric Editor’s Note 42 Considerations 77 Internet Resources 42 Summary 78 3. Emergency Health Services 45 5. Human Services in Disasters and Public Health Jeremy T. Cushman and Manish N. Shah Emergencies: Social Disruption, Individual Chapter Overview 46 Empowerment, and Community Resilience 79 The EHS System 46 EHS Components 46 Juliana Sadovich and Jonathan D.White Standard Operation of EHS 47 Chapter Overview 80 Current State of EHS 47 Introduction 80 Major EHS Concepts Associated With Disasters 48 Human Services “Under Clear Skies” 80 Resources for the EHS System 49 Human Security 81 Regional and Federal Assets 49 What Is Social Well-Being? 82 Critical Resources 50 Empowerment 82 Patients’ Access to EHS During a Disaster 51 Human Services in Disaster Response and Recovery 83 Major EHS Issues 52 Theories Supporting the Role of Nurses in Human System Survey 52 Services 84 Resource Availability 53 The Role of Nurses in Human Services 84 Communication and Coordination 54 Case Management in Disasters 85 How to Deal With the Influx 56 Summary 86 Summary 57 Study Questions 86 Critical Actions 58 4. Hospital and Emergency Department Preparedness 61 II DISASTER MENTAL HEALTH David Markenson Chapter Overview 62 6. Understanding the Psychosocial Impact Introduction 62 of Disasters 93 Hospital Preparedness 63 Kathleen Coyne Plum and Elizabeth C. Meeker Hazard Vulnerability Analyses 63 Chapter Overview 94 The Hospital Emergency Management Committee 64 Bioterrorism and Toxic Exposures 95 Alliance Building and Community-Based Planning 64 Community Impact and Resource Assessment 96 Hospital Preparedness for Children 64 Reducing Resistance to Psychosocial Intervention 97 Phases of Emergency Planning 65 Normal Reactions to Abnormal Events 97 Mitigation Measures 65 Resiliency in the Face of Disaster 98 Preparedness Efforts 65 The Response Phase 66 Special Needs Popluations 98 Children and Youth 99 The Recovery Function 66 Older Adults 99 Disaster Standards of Care 66 The Seriously Mentally Ill 101 Hospital Disaster Planning 67 Cultural and Ethnic Subgroups 101 Surge Capacity 67 Disaster Relief Personnel 101 Staffing 67 Nurses and Hospital Personnel 102 Credentialing 68 Mental Health Counselors 103 Stockpiling and Logistics 68 Community Reactions and Responses 103 Resource Inventories 68 Mourning, Milestones, and Anniversaries 104 Security Issues 68 HAZMAT/CBRNE Readiness 69 Summary 105 Collaboration and Integration With Public Health 69 Study Questions 106 Equipment and Supplies 69 Internet Activities 106 Utilities 69 Facility Evacuation 70 Drills and Exercises 70 7. Management of the Psychosocial ED Disaster Operations 70 Effects of Disasters 111 Trauma Centers 70 Elizabeth C. Meeker, Kathleen Coyne Plum, and Alternate Care Sites (ACS) 71 Tener Goodwin Veenema Incident Command System 71 Chapter Overview 112 Management of a Mass Casualty Situation 72 Initial Evolvement of MCS 72 The Mental Health Response Team 112 Casualties Flow to the Hospital 72 Recruitment, Screening, and Training 113 Casualties Flow Within the Hospital 73 Disaster Mental Health Interventions 114 Patient Triage 73 Psychological First Aid 114 Principles of Initial Hospital Management 75 Crisis Intervention 115 Use of Radiology 75 Social Support 115 Operating Room 75 Psychological Triage 116 Secondary Transport 75 Mental Health Referrals 116 Re-Assessment Phase 75 Acute Stress Disorder 117 Communication and Manpower Control 75 Posttraumatic Stress Disorder 117 Information Center and Public Relations 76 PTSD in Children 118Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xiv 8/7/2012 10:27:44 PM
  15. 15. CONTENTS xv Interventions With Special Populations 118 Children and Youth 118 III DISASTER MANAGEMENT Children’s Disaster Mental Health Concept of Operations Model 119 9. Legal and Ethical Issues in Disaster Older Adults 119 Response 149 Individuals With Mental Illness 119 Kevin D. Hart Cultural, Ethnic, and Religious Subgroups 119 Chapter Overview 150 Disaster Relief Personnel 119 Legal and Ethical Framework and Background 150 Managing Transitions 120 Introduction to the Legal System 150 When Grief and Stress Go Awry 120 Effect of Law on Nursing Professionals 150 Traumatic Grief (Complicated Bereavement) 121 Relationship Between Ethical and Legal Obligations 151 Evidence-Based Practices in the Treatment of Proposed Model State Acts 152 ASD and PTSD 122 The Role of Government in a Public Health Crisis 153 Recommended with Substantial Clinical Local Government 153 Confidence (Level I) 123 State Government 153 Recommended with Moderate Clinical Federal Government 154 Confidence (Level II) 123 May Be Recommended in Some Cases Specific Legal and Ethical Issues 154 (Level III) 123 Privacy Issues 154 Not Recommended (No Evidence) 123 Reporting of Diseases 154 Utilizing Technology as an Adjunct to Intervention and Disclosure of Health Information 155 Treatment 123 Quarantine, Isolation, and Civil Commitment 156 Vaccination 157 Critical Incident Stress Management 123 Treatment for Diseases 158 Psychological Debriefing 123 Screening and Testing 158 The Debriefing Controversy 124 Professional Licensing 159 Summary 125 Resource Allocation 160 Study Questions 125 Professional Liability 161 Internet Activities 125 Provision of Adequate Care 162 Selected Ethical Issues 163 Summary 164 8. American Red Cross Disaster Health Services and Study Questions 164 Disaster Nursing: National Capability—Local Community Impact 131 10. Crisis Communication: The Role of the Dianne Yeater, Sharon A. R. Stanley, and Valerie Cole Media 167 Chapter Overview 132 Introduction 132 Brigitte L. Nacos Chapter Overview 168 International Red Cross and Red Crescent Introduction 168 Movement 132 Effects of Media Coverage on Perceptions of Congressional Charter 132 Preparedness 169 American Red Cross Historical Background 133 Divergent Objectives of Terrorists 170 Overview of American Red Cross Disaster Services 135 Crisis and Emergency Risk Communications 171 American Red Cross Disaster Partners 136 Emergency Risk 172 The NRF and the Red Cross 136 Communication Principles 172 The National Emergency Repatriation Plan What the Public Will Ask First 172 and the Red Cross 137 What the Media Will Ask First 172 The Aviation Disaster Family Assistance Act Judging the Message 172 and the Red Cross 137 Five Key Elements to Build Trust 172 American Red Cross at the Local, Regional, and Media Platforms to “Go Public” 173 National Levels 138 Mass-Mediated Emergency Response Efforts 174 Red Cross Nursing 138 The Case for Media-Monitors 174 Office of the Chief Nurse and Red Cross Nursing 139 The Future of Red Cross Nursing: a Blueprint for Action 139 Cooperation Is Better Than Confrontation 174 Role of the American Red Cross Nurse During a Disaster 140 Reporters Are Not Always Entitled to Access 175 Disaster Health Services Concept of Operations 140 How to Work With Reporters 176 Functional Needs and Support Services 140 Information Sought by the Media 176 Disaster Health Services 141 What Is News? 176 What They Do 141 Media and Crisis Coverage 176 Disaster Health Services Team 141 Media Availability or Press Conferences “In Person” Tips 176 Assignment Settings 141 Social Media and the Internet 177 Disaster Mental Health 142 The Human Face of Emergency Responders 177 What They Do 142 Summary: Mass-Mediated Emergency Response 178 Staff Mental Health 142 Study Questions 178 Staff Wellness 142 What They Do 142 Shelter Nursing—The Art of Disaster Care 143 11. Disaster Management 181 Disaster Health Services Competencies 143 Kristine M. Gebbie and Kristine Qureshi Shelter—Initiating the Response 143 Chapter Overview 182 Equipment and Supply Lists 143 Introduction 182 Shelter Intake Screening Tool 144 Classifications of Disasters 183 Maintaining Shelter Operations 144 Internal Disaster 183 Transition and Closing of Shelters 144 External Disaster 184 Summary 144 Combined External/Internal Disaster 184Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xv 8/7/2012 10:27:45 PM
  16. 16. xvi CONTENTS The Role of Leadership 185 Medical and Nursing Aid Stations 230 The Disaster Management Process 186 Transportation Considerations 230 Introduction to HICS 189 Communication Systems 231 HICS Structure 191 Staffing 231 Specific HICS Functional Roles 192 Documentation 231 Communication During an Emergency Event 195 Mass Casualty Incidents 231 Adapting Care to the Context 195 Practice Parameters for Nursing Care 232 Recovery 196 Nursing Assessments 232 Evaluation and Follow-Through 197 Nursing Therapeutics and Core Competencies 233 Summary 197 Summary 233 Study Questions 198 Useful Links 198 14. Management of Burn Mass Casualty Incidents 237 12. Disaster Triage 201 Christopher Lentz, Dixie Reid, and Brooke Primomo Lou Romig Chapter Overview 238 Chapter Overview 202 Preparedness/Planning 238 Basic Principles of Disaster Triage 202 Mitigation 239 Phases of Disaster Triage: From the Field to the Hospital 205 Response 240 Basic Differences Between Daily Triage and Burn Triage in MCIs 240 Disaster Triage at the Hospital 207 Pathophysiology of Burn Injury 240 Daily Triage in the Hospital Setting 208 Management of a Mass Casualty Burn Patient 241 In-Hospital Triage Systems for Daily Operations 208 Primary Survey 241 Disaster Triage in the Hospital Setting 209 Stop the Burning Process 241 Prehospital Disaster Triage 211 Airway/Breathing/Circulation 241 Simple Triage and Rapid Treatment 213 Other Considerations 241 Jumpstart 214 Fluid Resuscitation 241 Triage Tags 217 Other Initial Priorities 242 Disaster Triage for Hazardous Material Disasters 218 Secondary Survey 242 In the Field (Sidell, William, & Dashiell, 1998) 219 Burn Wound Care 243 Hot Zone 219 Pain Control 243 Warm Zone 219 Walking Wounded 243 Cold Zone 219 Special Topics 243 At the Hospital 219 Chemical Burn Injury 243 Warm (Dirty) Zone 219 Electrical Injury 244 Clean Zone 219 Radiation Injury 244 Summary 220 Recovery 244 Study Questions 221 Evaluation 244 Summary 245 13. Emergency Medical Consequence Planning 15. Traumatic Injury Due to Explosives and for Special Events, Mass Gatherings, and Mass Blast Effects 253 Casualty Incidents 223 Tara L. Sacco Tener Goodwin Veenema Chapter Overview 254 Chapter Overview 224 Introduction 254 Mass Gatherings and Special Events 224 Explosives: Classification and Physics 254 Health Care Emergency Management 225 Mechanisms and Patterns of Injury 256 Emergency Medical Consequence Planning 225 Blast Injuries and Clinical Care of Survivors 258 Ancillary Personnel 226 Traumatic Brain Injury 258 Lack of Guidelines 226 TM Rupture 259 Goals of Emergency Care at Mass Gatherings 226 Pulmonary Injury 259 Historical Lessons 227 Abdominal Injury 260 Type of Event 227 Additional Considerations 261 Duration of the Event 227 Military and Civilian Casualties 262 Characteristics of the Crowd 227 Event Management 262 Weather and Environmental Summary 262 Influences 228 Study Questions 263 Heat 228 Heat Rash 228 Heat Cramps 228 IV GLOBAL DISASTERS AND COMPLEX HUMAN Heat Syncope 228 Heat Exhaustion 228 EMERGENCIES Classic Heat Stroke 228 Exertional Heat Stroke 229 16. Natural Disasters 265 Cold 229 Tener Goodwin Veenema and Linda Young Landesman Frostnip 229 Chapter Overview 266 Frostbite 229 Introduction 266 Hypothermia 229 Types and Consequences of Natural and Environmental Alcohol and Drug Use 229 Disasters 266 Crowd Density and Mood 230 Severity of Damage 267 Site Layout 230 Trends in Natural Disasters 267Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xvi 8/7/2012 10:27:45 PM
  17. 17. CONTENTS xvii Cyclones, Hurricanes, and Typhoons 268 Summary 301 Risk of Morbidity and Mortality 271 Study Questions 302 Drought 271 Risk of Morbidity and Mortality 272 18. Climate Change and the Nurse’s Role in Earthquake 272 Risk of Morbidity and Mortality 272 Policy and Practice 305 Prevention/Mitigation 273 Karen L. Levin and Thomas Chandler Epidemics 273 Chapter Overview 306 Flood 273 Introduction 306 Risk of Morbidity and Mortality 274 Basic Climate Change 306 Heat Wave 274 Climate Change Impact on Human Risk of Morbidity and Mortality 274 Health 307 Prevention 275 U.S. and Global Climate Change Health Effects 307 Tornado 276 Climate Change Relationship to Health Effects 308 Risk of Morbidity and Mortality 276 Cross-Cutting Issues—Vulnerable and Prevention/Mitigation 276 Susceptible Populations 308 Thunderstorms 277 Children 308 Risk of Morbidity and Mortality 277 Elderly 309 Tsunamis 277 Urban Poor 309 Risk of Morbidity and Mortality 278 Regional U.S. Variations 309 Volcanic Eruptions 278 Selected Health Outcomes 309 Risk of Morbidity and Mortality 279 Thermal Extremes (Heat and Cold) 309 Activities for When a Volcano Erupts 279 Extreme Weather Events 309 Protection From Falling Ash 279 Vector-Borne and Zoonotic Diseases 310 Food- and Water-Borne Diseases 310 Winter/Ice Storms 279 Risk of Morbidity and Mortality 280 Climate Change and the Nursing Interface: Mitigation Versus Prevention/Mitigation 280 Adaptation 310 Wildfires 281 What’s Being Done? 311 Risk of Morbidity and Mortality 281 Global Efforts—WHO 311 Prevention/Mitigation 281 Federal Efforts 311 National/State/Local 311 Summary 282 Nurses in Action: Educate–Advocate 311 Study Questions 282 Professional Position Papers/Statements 311 Internet Activities 283 Responding to the “Call for Action” 311 Framing Nurses’ Roles and Response 312 17. Restoring Public Health Under Disaster What Still Needs to Be Done? 312 Conditions: Basic Sanitation, Water and Food Summary 313 Additional Recommended Reading and Useful Links 314 Supply, and Shelter 287 Study Questions 314 Joy Reed, Tener Goodwin Veenema, and Internet Activities 314 Adam B. Rains Chapter Overview 288 19. Environmental Disasters and Emergencies 317 Basic Public Health Functions 288 Tener Goodwin Veenema Health Promotion 289 Chapter Overview 318 Maslow’s Hierarchy of Needs 289 Environmental Emergencies 318 Risk Factors for Infectious Disease Outbreaks From Environmental Disasters 318 Disasters 290 Environmental Public Health Tracking: Protecting Communities Rapid Assessment of Population Health Needs 290 Through Integrated Environmental Public Health The Role of the Public Health Nurse Following a Disaster 291 Surveillance 319 The Sphere Project 291 Environmental Protection Agency 319 Vulnerabilities and Capacities of Disaster-Affected Examples of Environmental Hazards and Their Impact 319 Populations 292 Air Pollutants 319 Water 292 Chemical Spills 320 Sanitation 294 Risk Management Program Rule (40 CFR 68) 320 Access to Toilets 295 Land, Waste, and Brownfields 320 Excreta Disposal Standard 1: Access to, and Numbers of, Mold 321 Toilets 295 Oil Spills 321 Design of Toilets 295 Pesticides 322 Excreta Disposal Standard 2: Design, Construction, and Use of Radiation Release 323 Toilets 295 Water 323 Foodborne Illness 295 Pharmaceuticals 323 Food Safety 296 Summary 323 Magnitude of Foodborne Illness 296 Study Questions 324 Major Foodborne Diseases From Microorganisms 297 Internet Activities 324 Foodborne Illness Investigation 297 Challenges in Food Safety 298 20. Complex Humanitarian Emergencies 333 Food Safety Is Essential for Disease Prevention in the Aftermath of a Disaster 298 Frederick M. Burkle, Jr. Shelter From the Elements 299 Chapter Overview 334 Personal Hygiene 300 Defining CHEs 334 Vector Control 300 Conventional Warfare 334 Methods of Vector Control 301 Unconventional Warfare 334Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xvii 8/7/2012 10:27:45 PM
  18. 18. xviii CONTENTS Major Characteristics 335 Psychoincapacitants 370 International Response 335 Pesticides 371 Measuring the Human Cost 336 Effects of Chemical Terrorism 371 Chemical Contamination of Water, Food, Beverages, and Consumer Assessments, Data Collection, and Analysis 336 Products 371 Direct Indices 337 Challenges Posed By a Chemical Terrorist Attack 372 Indirect Indices 337 Epidemiological Models 337 Bioterrorism 372 Bioterrorism and Delivery of BW Agents 373 Developing Country Health Profiles 338 What Agents Might the Bioterrorist Use? 373 Developed Country Health Profiles 339 Smallpox 374 Chronic/Smoldering Country Health Profiles 339 Sabotage (Food and Water Contamination) Threats 374 Postconflict Phase Consequences 340 Challenges Posed by Bioterrorism 375 Shifting Aid From Rural to Urban Environments 340 Case Examples 375 Future Complex Humanitarian Emergencies 341 The Rajneeshees 375 Professionalization of the Humanitarian Workforce 342 Aum ShinrikYo 376 Summary 342 The 2001 Anthrax Attacks 377 Mass Psychogenic Illness 377 21. Disaster Relief Nursing in the 21st Century 345 Summary 378 Pat Deeny and Kevin Davies Study Questions 378 Chapter Overview 347 Introduction 347 23. Surveillance Systems for Detection of The Scale of Disasters Worldwide 348 Biological Events 381 The Growth of Aid Relief Organizations 350 Erica Rihl Pryor and Gary W Milligan . The Contribution of Nursing 351 Chapter Overview 382 Development of an International Nursing Workforce 351 Introduction 382 Cultural Awareness and Sensitivity 352 How Is Disease Occurrence Measured? 382 Ethical Issues in Disaster Relief Nursing 352 What Is Public Health Surveillance? 383 Background 354 Data Collection 383 Issue 354 Data Analysis and Interpretation 383 Solution 354 Data Dissemination 383 Quality Assurance in International Disaster Surveillance System Evaluation 384 Response: The Humanitarian Charter and the What Systems Are Used to Collect Surveillance Data? 384 Minimum Standards 354 Surveillance System Example: Influenza 384 Communication and Transport as Major Obstacles to the Other Infectious Disease Surveillance Systems 385 Relief Effort in International Disasters 356 What Surveillance Initiatives Have Occurred in Response to Care of Displaced Persons or Refugee Populations 357 Bioterrorist Threats? 387 Application of the Nursing Metaparadigm and Selected What Are the Roles of State and Local Health Departments in Grand Theories From Nursing Science 358 Disease Surveillance Systems? 387 Selection of Appropriate Models or Grand Theories 358 The Role of Clinicians in Infectious Disease Surveillance 387 Background 359 Syndromic Surveillance 388 Issue 359 Future Directions: Biosurveillance 389 Solution 359 Infoveillance 389 Summary 360 Surveillance Partners 391 Study Questions 360 What Is the Role of Veterinary Surveillance Systems? 391 How Do Emergency Information Systems Fit Into a Biosurveillance System? 391 V DISASTERS CAUSED BY CHEMICAL, BIOLOGICAL, Summary 392 AND RADIOLOGICAL AGENTS Study Questions 392 22. Biological and Chemical Terrorism: A Unique 24. Biological Agents of Concern 395 Threat 363 David C. Pigott, Ziad N. Kazzi, and Sarah D. Nafziger Eric Croddy and Gary Ackerman Chapter Overview 396 Chapter Overview 364 Classification of Biological Agents of Concern 396 Chemical Terrorism and Bioterrorism Defined 365 Category A Agents 396 CB Warfare Agents: Quick Definitions 365 Category B Agents 397 Why Would Terrorists Use Chemical or Biological Category C Agents 397 Agents? 366 Biosafety Laboratory Classification 397 Disinformation or Hoaxes 366 Anthrax 397 How Might the Choice of CB Weapons History 397 Differ Between Military and Terrorist Use? 367 Epidemiology 398 Some Unique Aspects of a Chemical or Biological Terrorist Classification and Etiology 398 Incident 368 Pathogenesis 399 What Are the Real Risks of Chemical Terrorism/Bioterrorism? 368 Biosafety Issues, Protection, and Isolation 400 Chemical Terrorism 368 Public Health Implications 401 Delivery of Chemical Agents 368 Vaccination and Postexposure Prophylaxis 401 Nerve Agents 369 Treatment 401 Tissue (Blood) Agents 369 Botulism 401 Lung Irritants 370 History 401 Vesicants 370 Epidemiology 402Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xviii 8/7/2012 10:27:46 PM
  19. 19. CONTENTS xix Classification and Etiology 402 Laboratory Detection 421 Pathogenesis 402 Laboratory Methods for Detection 423 Clinical Manifestations and Diagnosis 402 Laboratory Response Network 422 Laboratory Issues, Protection, and Isolation 403 Future Directions for Detection 423 Public Health Implications 403 Biosensors 423 Vaccination and Postexposure Prophylaxis 403 Syndromic Surveillance 423 Treatment 403 Diagnostic Decision Support Systems 423 Plague 403 Educational Preparation 424 History 403 Summary 424 Epidemiology 404 Study Questions 424 Classification and Etiology 404 Internet-Based Activities 425 Pathogenesis 404 Clinical Manifestations and Diagnosis 404 Biosafety Issues, Protection, and Isolation 404 26. Infectious Disease Emergencies 429 Public Health Implications 404 Kristine M. Gebbie and Tener Goodwin Veenema Vaccination and Postexposure Prophylaxis 405 Chapter Overview 430 Treatment 405 Brief History 430 Tularemia 405 The Burden of Infectious Disease 431 History 405 Factors Contributing to the Spread of Infectious Epidemiology 405 Classification and Etiology 405 Diseases 431 Pathogenesis 405 Immune Status 431 Clinical Manifestations and Diagnosis 406 Climate and Weather 432 Biosafety Issues, Protection, and Isolation 406 The Changing Environment 432 Public Health Implications 406 Risk Behaviors 432 Vaccination and Postexposure Prophylaxis 406 International Travel and Commerce 432 Treatment 406 Diseases of Importance 433 Smallpox 406 Cholera 433 History 406 HIV/AIDS 433 Epidemiology 407 Influenza 434 Classification and Etiology 407 Marburg Hemorrhagic Fever 436 Pathogenesis 407 Severe Acute Respiratory Syndrome 436 Clinical Manifestations and Diagnosis 407 Smallpox 438 Biosafety Issues, Protection, and Isolation 408 Future Directions 438 Public Health Implications 408 Summary 439 Vaccination and Postexposure Prophylaxis 408 Study Questions 440 Treatment 408 Viral Hemorrhagic Fevers 409 27. Medical Countermeasures Dispensing 445 Epidemiology 409 Classification and Etiology 409 Susan Sullivan Pathogenesis 410 Chapter Overview 446 Clinical Manifestations and Diagnosis 410 Introduction 446 Biosafety Issues, Protection, and Isolation 411 The Division of Strategic National Stockpile 446 Public Health Implications 411 The CHEMPACK Program 447 Vaccination and Postexposure Prophylaxis 411 Radiological Countermeasures 448 Treatment 411 Shelf-Life Extension Program (SLEP) 448 Summary 412 Organizing to Respond 448 Study Questions 412 Structuring Dispensing Programs 449 Cities Readiness Initiative 452 Medical Countermeasures Planning Elements 452 25. Early Recognition and Detection The Public Readiness and Emergency Preparedness of Biological Events 415 (PREP) Act 453 Erica Rihl Pryor Pediatric Countermeasures Planning 454 Chapter Overview 416 Cross-Jurisdictional Planning 456 Introduction 416 Summary 456 Early Recognition of Events 416 Surveillance 416 28. Chemical Agents of Concern 459 Clinical Recognition 417 Acute Care Settings 417 John G. Benitez Community-Based Settings 417 Chapter Overview 460 Community-Health Settings 418 Introduction 460 Epidemiological Approach to Recognition 418 Chemical Agents in the Environment 460 Recognition of Unusual Patterns 418 Hazmat Emergency Response 461 Health Indicator Data 418 Detection of Chemical Agents 461 Epidemiological Clues to a Biological Event 418 Chemical Agents of Concern 463 Syndromic (Clinical) Approach to Recognition 419 Antidotes 463 Syndromes Associated With CDC Category A Agents 419 Nerve Agents 463 Botulism-Like Syndrome 420 Recognizing Nerve Agents 464 Hemorrhagic Illness 421 Duration/Mortality 464 Rash 421 Patient Assessment 464 Respiratory Syndrome 421 Clinical Diagnostic Tests 465 Other Syndromes 421 Patient Management 465 Clinical Presentations for Other Potential Bioterror Agents 421 Treatment 465Veenema_08647_PTR_CH00_06-08-12_i-xxxiv.indd xix 8/7/2012 10:27:46 PM