Natural Disaster and the Role of Public Health Nurse

207WORKPLACE HEALTH & SAFETY • VOL. 62, NO. 5, 2014

CONTINUING EDUCATION

The major motion picture World War Z tells the apocalyptic story of a global war fought against humans who have been infected with a mysteri- ous virus that causes them to turn into flesh-eating zom- bies. Although it is highly unlikely the United States will face a zombie apocalypse in the near or distant future, the Centers for Disease Control and Prevention (CDC) de- signed a preparedness campaign capitalizing on the popu- larity of zombies in social media entitled, “Preparedness 101: Zombie Apocalypse.” The CDC purports, “If you’re ready for a zombie apocalypse, then you’re ready for any emergency!” It is the intent of the CDC that individuals, families, and communities will take action to be prepared for any natural or manmade disaster. This “all-hazards”

approach is central to the disaster preparedness frame- work used by the CDC and the U.S. Federal Emergency Management Agency (FEMA). Emergency response teams and health care providers across the nation are now trained to respond to disasters uniformly using the Inci- dent Command System. Natural Disaster and the Role of Public Health Nurse

Nurses are the largest group of health care providers and are considered essential personnel in a disaster. Ac- cording to a 2012 report released by the U.S. Department of Labor Bureau of Labor Statistics, it is predicted that the number of nurses will increase from 2.74 to 3.45 million between 2010 and 2020. Nurses across the nation have the potential to significantly impact disaster preparation in the workplace and community. This article provides a brief review of literature about disaster readiness, in- cluding “lessons learned” and ethical-legal expectations of nurses during a disaster. The article also provides a preparation guide (including resources) for nurses in the workplace so they can effectively facilitate preparation for hurricanes, earthquakes, pandemics, terrorist attacks, and even zombie invasions.

LITERATURE REVIEW Lessons Learned From Previous Disasters

In a striking book about disaster, Ripley (2008) dis- cusses “who survives when disaster strikes—and why.”

ABSTRACT The Centers for Disease Control and Prevention (CDC) urges citizens everywhere to prepare for any emergency that might occur in their areas. In conjunction with the U.S. Federal Emergency Management Agency and the U.S. Depart- ment of Homeland Security, the CDC has designed a four-step plan (“Ready America”) to assist all Americans in taking action. As the largest body of health care providers, nurses across the nation have the potential to contribute substantially to disaster readiness in the workplace and the community. This article reviews lessons learned from previous disasters and also presents an overview of ethical-legal considerations related to disaster nursing care. In addition, a preparation guide for nurses in the workplace and on the home front is presented. Disaster preparation resources are also provided. [Workplace Health Saf 2014;62(5):207-213.]

Disaster Readiness for Nurses in the Workplace Preparing for the Zombie Apocalypse

London Draper Lowe, MSN, RN; Faye I. Hummel, PhD, RN, CTN

ABOUT THE AUTHORS Ms. Draper Lowe is Associate Professor of Nursing, Weber State Uni-

versity School of Nursing, Ogden, Utah. Dr. Hummel is Interim Co-Direc- tor and Professor of Nursing, University of Northern Colorado, School of Nursing, Greeley, Colorado.

Submitted: November 4, 2013; Accepted: February 10, 2014; Posted online: May 6, 2014

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Correspondence: London Draper Lowe, MSN, RN, Weber State University, School of Nursing, 3875 Stadium Way, Dept. 3903, Odgen, UT 84408-3903. E-mail: LDraper2@weber.edu

doi:10.3928/21650799-20140422-05

208 Copyright © American Association of Occupational Health Nurses, Inc.

The author notes that “91% of Americans live in places at a moderate-to-high risk of earthquakes, volcanoes, torna- dos, wildfires, hurricanes, flooding, high-wind damage, or terrorism”(p. xvi) and “80% of Americans live in cit- ies” (p. xv) where they make almost none of the neces- sities they need for themselves. In disaster situations, the limitations individuals face are the same ones they are afflicted with in everyday life. For example, individuals with physical limitations or low physical abilities and conditioning “were three times as likely to be injured while evacuating the Trade Center on 9/11” (p. 87). In ad- dition, on 9/11, “women were almost twice as likely to get injured while evacuating. . .because many took off their heels halfway through the evacuation and had to walk barefoot” (p. 89). Further, companies that had routine di- saster drills were the most successful in evacuating all of their employees safely. “Only 45% of 445 Trade Center workers interviewed after 9/11 had known the buildings even had three stairwells” (p. 19) and a substantial major- ity of individuals had absolutely no idea how to traverse the transfer halls to the stairwells for descent to the street. Thus, physical health, attire, conditioning (training), and knowledge became central factors in surviving this ter- rorist attack. Nurses in the workplace can improve the preparedness of employees in these key areas.

The Federal Financial Institutions Examination Council (2012) released a report on Lessons Learned From Hurricane Katrina: Preparing Your Institution for a Catastrophic Event. The report highlights some of the most valuable insights gained retrospectively from this natural disaster:

1. Know your workplace disaster plan and conduct re- alistic disaster drills that include “all critical func- tions and areas” (p. 3). The most important aspect of any disaster drill is the “hot wash” or post-simulation review of what worked, what did not work, what can be improved, and any modifications that should be made. It is critical to foster an atmosphere of team- work and ensure that everyone plays their role in a disaster.

2. Anticipate major disruptions in communication for prolonged periods of time. Workplace evaluations should include questions such as, “What alternate means of communication are available?” “If nor- mal means of communication are lost for a week or more (i.e., with damage or loss of power), what will the impact be?” “How will communication be orga- nized?”

3. Nurses should consider that critical personnel may not be available. They may be injured or unable to reach their assigned rescue locations. Questions to anticipate in this area include, “What will the chain of command be?” “What alternate options may be needed?” “Which personnel can be cross-trained to assist in critical areas?”

4. Planning for people is essential. Widespread disasters will overwhelm health care services. Every work- place should maintain at a minimum first aid supplies including equipment and supplies for individuals

with special needs. Replacement supplies will likely be difficult to obtain for extended periods of time and plans should be adjusted accordingly. Questions to address in this area include, “Which employees have special needs?” “Where are the designated meeting places in a disaster event?” “If the building is dam- aged, what alternate meeting places and shelter are available?” “What water sources and supplies will be available for 1 to 2 weeks?” “What food sources will be available for 1 to 2 weeks? “How will the time of year affect shelter needs?”

5. Discussions of workplace expectations during a di- saster should occur in advance of any crisis.

In 2011, when an EF-4 tornado tore through Tusca- loosa, Alabama, the DCH Regional Medical Center be- came a beacon on the hill for a city that witnessed ma- jor devastation in a matter of minutes. Ultimately, more than 900 patients were treated in 12 hours (A. Lee, per- sonal communication, April 28, 2012). By 8:30 p.m., the emergency room and six alternate care sites were full to capacity. The cafeteria and hallways were used to treat patients. The din in the emergency room caused by pa- tients, caregivers, and family members looking for loved ones was so loud that communication was next to impos- sible. Security was a major issue. In addition, maintaining confidentiality was a significant problem with many un- identified patients, including children who could not (or would not) talk in the aftermath of the traumatic event. The generator, which switched on when power was lost, was at maximum pull because the hospital was using vir- tually every piece of equipment available all at the same time. The hospital lost water pressure, which interfered with the sterilization of instruments. Staffing was also a challenge. Trauma surgeons were needed. Obstetrical physicians were on-site. Communications outside of the hospital were difficult to impossible. Text messaging was minimally successful. The use of social media became a new avenue for exchanging information.

The following are some of the most important les- sons learned from the Tuscaloosa disaster. Occupational health nurses may be the primary or only caregivers for injured employees. Emergency strategies related to staff- ing should be discussed and planned accordingly. Natural Disaster and the Role of Public Health Nurse

1. Nurses may be knowledgeable about treating many types of injuries, such as crush injuries, bone frac- tures, and lacerations, but most workplace environ- ments will typically be unprepared for the vast num- ber of victims who may present at the same time in a large-scale event.

2. Supplies are always rapidly depleted. It is critical to stockpile the most essential provisions, such as bandages, sutures, triage tags, and identification bands, in addition to contracting with vendors, if applicable, for delivery of extra supplies depending on the work facility and type of disaster. Triage sup- plies will be vital emergency response items for oc- cupational health nurses working in all workplace environments. Natural Disaster and the Role of Public Health Nurse

209WORKPLACE HEALTH & SAFETY • VOL. 62, NO. 5, 2014

3. Adding a generator or an additional generator should be considered depending on the critical needs of the workplace. In the case of Tuscaloosa, an additional generator for the emergency room was needed be- cause the bulk of the care initially occurred in the emergency department.

4. Retrofitting areas such as conference rooms, cafete- rias, and hallways with red plugs connected to gen- erator power should be considered.

5. An area away from the central victim treatment lo- cation where volunteer personnel can report to re- duce confusion and facilitate assignments should be designated.

6. Contingency plans should be made for loss of water pressure.

7. It is necessary to create a venue for information shar- ing via social media and educate personnel on emer- gency communication plans.

8. Additional security measures should be considered. A sudden influx of panicked masses poses numerous security dangers for any workplace environment.

Post-disaster, the DCH Regional Medical Center de- veloped a “Pod System” for the emergency department that incorporated an emergency department coordinator, triage coordinator, and transfer coordinator. This system is now used on a daily basis and will be “routine” during any future disaster. This new routine also incorporated external triage into the system—a plan that includes lev- els of triage that occur outside of the hospital building (Lee, 2012).

Occupational health nurses must identify alternative locations other than the health service for coordinating triage and treatment and storing supplies to facilitate vic- tim stabilization and minimize chaos. In addition, occu- pational health nurses should finalize plans and incorpo- rate drills for personnel who are trained or can be trained to assist with care during a crisis.

Several commonalities were found in the lessons learned from the Tuscaloosa disaster and the devasta- tion left by Hurricane Katrina in 2005. In both situations, nurses were at the heart of disaster care and social me- dia emerged as an invaluable means of communication and calling for support. Social media also played a criti- cal role during Hurricane Sandy in 2012. The U.S. De- partment of Homeland Security released a 2013 report entitled Lessons Learned: Social Media and Hurricane Sandy, which described the explosion of activity before, during, and after the storm. As noted in the report, “Sandy marks a shift in how social media is now used for pre- paredness, response, and recovery to disasters” (p. 30). Additionally, Bernard and Mathews (2008) recounted that walkie-talkies were used during Hurricane Katrina until the batteries were exhausted when cell and direct connect phones lines were down. Post-disaster, “all hospitals and nursing homes have obtained 800 MHz satellite radios to improve the communication process” and the city of New Orleans “has also implemented a P25 (voice and data) communication system that ensures interagency commu- nication” (p. 222). Further, as with post-disaster review

and planning in Tuscaloosa, health care facilities in New Orleans have retrofitted buildings with additional genera- tors, extra fuel, and added emergency outlets. Many hos- pitals and other workplace environments are now storing “meals-ready-to-eat (MREs)” and are creating alternate water sources (e.g., digging wells). Disaster drills occur frequently, are taken seriously, and now include person- nel trained on the critical incident stress management sys- tem, “a system that will assist in the debriefing process after disaster” (p. 222).

Ethical and Legal Considerations During Disasters Events such as the 2009 H1N1 pandemic bring into

focus additional ethical-legal considerations that should be addressed in advance of a crisis, such as, “Is it pro- fessionally acceptable for a nurse to stay home during a pandemic?” (Chamings, 2008, p. 202; James, 2008). The 2003 SARS outbreak demonstrated that it is difficult to predict what nurses will do during a pandemic or bio- terrorism event. Chamings (2008) notes, “The American Nurses Association (ANA) Code of Ethics specifies that ‘the nurse owes the same duties to self as to others, in- cluding the responsibility to preserve integrity and safe- ty’” (p. 202). The author also notes that many nurses will likely not be in the workplace during a pandemic crisis, so plans must be made accordingly. On the other hand, James (2008) states that “nurses and healthcare organiza- tions have special responsibilities and obligations” that should be maintained even during crisis events (p. 203). The author adds, “Nurses have chosen a profession that has inherent risks. . .and the risks of caring for sick people have always been borne by nurses” (p. 203).

James (2008) reminds readers that multiple re- sources will be available and are part of disaster plan- ning. Plans include protecting front-line caregivers against disease via vaccinations and prophylaxis so they are available to care for those in need. Nurses should know their workplaces’ policies about disaster events, including communication plans and expectations for participation, as well as whether institutional plans in- clude sheltering options for family members and pets (as with Hurricane Katrina). Natural Disaster and the Role of Public Health Nurse

In 2006, the ANA addressed the unique ethical-legal issues for nurses in disaster situations. Specifically, how will the standards of care be altered to take into account the unique nature of patient care during disaster situa- tions? As a result, in 2008, the ANA published a policy paper entitled, Adapting Standards of Care Under Ex- treme Conditions: Guidance for Professionals During Disasters, Pandemics, and Other Extreme Emergencies. This document provides guidance for central questions related to ethics and standards of care when nurses must make decisions in extreme circumstances. Decision- making during unusual or extraordinary conditions is altered toward a utilitarian approach wherein the goal is the “greatest good for the greatest number of individuals” (p. 10). Consequently, not every individual treated will receive optimal care. Disaster care decisions are made based on “the most that can be done” or “the best that can be done” (p. 10) under the circumstances presented.

210 Copyright © American Association of Occupational Health Nurses, Inc.

As outlined by the ANA, “this might include expanding the role of family members in monitoring patient status, or outpatient care for a condition that would normally be treated in an inpatient setting” (p. 10). Nurses should be- come familiar with state and institutional disaster stan- dards of care. The ANA recommends that nurses “seek additional training in emergency triage in order to under- stand the unusual decision criteria involved in conserving scarce health resources for those most in need of care and most likely to survive if it is provided” (p. 15).

Veneema (2013) addressed the plethora of ethi- cal-legal issues faced by nurses in disaster situations. Regarding maintenance of confidentiality, each state differs significantly regarding which diseases must be reported and to whom the information is reported. “In the event of a public health crisis resulting from a ter- rorist attack, nurses will need to keep current on any additional reporting requirements that may be imposed by state and local authorities” (p. 155). Another com- pelling issue is quarantine or isolation. “Today’s juris-

prudence recognizes the authority of the state to con- fine a person for public health purposes, but there must be a compelling state interest—which means signifi- cant risk for disease transmission” (p. 156). Regarding professional licensing, laws allow volunteer emergen- cy health care workers to cross state boundaries and provide care during a disaster without a license. Nurses must be registered within their resident state to prac- tice in another state during a disaster, even if the work is volunteer. This usually occurs through three main organizations that provide disaster care: the American Red Cross, the Medical Reserve Corps, and the Emer- gency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP). The ESAR-VHP is a federal program administered at the state level. It is designed to facilitate interstate collaboration. In addi- tion, the Uniform Emergency Volunteer Health Practi- tioners Act “provides legal safeguards for practitioners acting within their scope and in good faith” (Brewer, 2010, p. 3). Natural Disaster and the Role of Public Health Nurse

Sidebar 1

Key Questions to Address in Disaster Preparation for the Workplace 1. What are the top five most likely disasters in the local area?

2. What is the facility disaster plan and when was it last updated? What are the evacuation plans?

3. How often will disaster drills take place? How often will disaster supplies be checked?

4. What will the command structure be in a disaster? Is there a plan for alternate command structures (if needed)?

5. How safe is the facility building? When was the building last inspected?

6. What alternate care sites are available? Which sites would be appropriate depending on time of season and changes in weather?

7. If electricity is lost, what will the impact be and what contingency plans are in place?

8. What type of documentation will take place during a disaster? How will the facility track injured victims, including unidentified victims?

9. What alternate communication systems are available if normal communication systems are not functional?

10. How will staff be contacted if normal communication systems are down? Is there a plan for use of social media? Are all employees aware of this plan?

11. What are the current plans for staffing rotations, and do they need to be modified (e.g., changing 12-hour shift schedules to 6-hour schedules or even 2-hour schedules)? What staffing plans need to be in place depending on the particulars of a given workplace environment?

12. What alternate water sources are available? Will those sources be adequate for hydration and medical needs?

13. What sources of food will be available? If power is lost, will food sources be edible (i.e., do they need to be cooked or refrigerated)?

14. If sewer service is lost, what is the plan for waste and sanitation?

15. How will the facility address the threat of danger from looters? What security plans are in place?

16. What is the facility plan for addressing the psychological impact of disasters? Post-disaster, what is the plan for after-incident debriefing?

17. Does the facility have a designated public information officer to coordinate all communications and informa- tion throughout a disaster?

18. Could the facility handle twice the number of victims they are currently prepared for?

19. Does the facility offer shelter options for family and pets? What is the plan?

20. Does the facility have employees who might be excellent resources for disaster planning and disaster care?

211WORKPLACE HEALTH & SAFETY • VOL. 62, NO. 5, 2014

PREPARATION GUIDE FOR NURSES IN THE WORKPLACE

Most institutions currently have a disaster plan. It is judicious for nurses to understand their workplace di- saster plan, including contingencies that encompass the organizational strategy. Although the case examples pre- sented have been from hospital-based situations, the steps for preparation can be adapted to apply to all traditional workplace settings where occupational health nurses are employed. As noted by Bernard and Mathews (2008), “We had prepared for severe storms in the past” (includ- ing many factors related to staffing and patient care). . .but “several things required re-consideration” (p. 215). For example, the usual 12-hour shifts were reduced to 6-hour shifts due to increased stress during disaster care. As con- ditions worsened, the shifts were reduced to 2-hour inter- vals. Additionally, shelter and environmental safety was a high priority. Unsafe or extreme environmental condi- tions endangered the health of uninjured caregivers. For instance, during Hurricane Katrina the extremes of tem- perature (110°F) took a major toll on family and caregiv-

ers. Despite attempts to remain hydrated, many individu- als required intravenous fluids. With regard to supplies and equipment, it is impossible to estimate the impact of any given disaster. During Hurricane Katrina, the patient census at Memorial Medical Center was approximately 350 before the storm and 2,000 after the storm, including staff, family, and visitors. The hospital also housed more than 150 family pets. Distribution of resources depends on the type of disaster, the number of victims, and the scope of injuries. The staff at Memorial Medical Center persevered with patient and family care for 6 days before being rescued. Sidebar 1 lists some of the key questions to address in disaster preparation for the workplace. Natural Disaster and the Role of Public Health Nurse

As discussed by Schultz, Pouletsos, and Combs (2008), organizations must consider how to plan for alter- native scenarios. To plan for loss of electrical power, con- sider solar charging pads for electronics, solar flashlights, extra batteries, and chemical light sticks. To plan for loss of computers, consider stocking predetermined hard cop- ies of pertinent online documents such as drug handbooks and policy and procedure manuals and laminate “how-

Table 1

Disaster Resources for Nurses Resource Web Link Tips for Use

American Red Cross (ARC)

http://www.redcross.org/ The ARC site has excellent resources for staying informed via disaster alerts and preparedness tips. Nurses can volun- teer for their local chapter of the ARC. In some states there is active collaboration between the ARC and the MRC.

Centers for Disease Control and Prevention (CDC)

http://www.cdc.gov/ Nurses can stay current on global events by signing up for the CDC’s “Clinician Updates.” Go to the CDC’s Newsroom and subscribe to the CDC’s Newsroom Updates: http:// www.cdc.gov/media/subtopic/health.htm. The CDC site has tremendous resources for nurses, especially related to current national and international outbreaks and crises.

Community Emergency Response Team Training (CERT)

http://www.fema.gov/ community-emergen- cy-response-teams Click on “find nearby CERT programs.”

Nurses should consider CERT training and certification, which is provided (in most states) under the direction of local fire departments. This training assists nurses in networking with community resources and preparing to function as part of a local (neighborhood) team in disas- ter preparation and response.

The Emergency System for Advanced Registration of Volunteer Health Profes- sionals (ESAR-VHP)

http://www.phe.gov/ esarvhp/Pages/about. aspx

This site has information about volunteer registration. It is important the interested nurses register with their state ESAR-VHP programs such as the ARC and MRC.

Federal Emergency Man- agement Agency (FEMA)

http://www.fema.gov/ or “Ready” site: http:// www.ready.gov/

The main FEMA site has outstanding disaster-specific in- formation (such as earthquake, tornado, and hurricanes) with resources for preparedness. The “Ready.gov” site has excellent resources and information for becoming informed, creating a disaster plan, compiling a disaster kit, and getting involved in the community. There are also “ready” sites which contain local information by state. For example: “Be Ready Utah” http://beready.utah.gov

Medical Reserve Corps (MRC)

https://www.medicalre- servecorps.gov Click on “Find a Unit”

Nurses can volunteer for their local MRC. The MRC en- courages community collaboration by health profession- als during disaster events.

212 Copyright © American Association of Occupational Health Nurses, Inc.

to” instructions for nurses and volunteer caregivers who are not accustomed to providing emergency care. To plan for loss of heat or air conditioning, consider stocking ex- tra blankets and battery-operated fans. To plan for loss of sanitation facilities, consider stocking waterless hand cleansers and portable waste containers.

Disaster training scenarios should also include op- portunities for occupational health nurses to “think out- side the box.” A case in point, hospital-based nurses should contemplate how they might care for patients dur- ing ventilator failure, infusion pump failure, physiologic monitoring failure, or loss of suction. Schultz et al. (2008) offer creative alternative strategies for post-disaster care with limited resources. Occupational health nurses should consider the priority needs of their workplaces to maintain systems and safeguard employee health during emergency situations.

PERSONAL PREPARATION PRIOR TO INVASION

To facilitate workplace readiness, nurses must also design and implement a disaster plan for themselves and the significant people in their lives, preferably before the zombies arrive. If nurses are unprepared on the home front, their ability to respond in an emergency may be compromised and their level of effectiveness may be ad- versely affected by significant potential for distraction. Personal preparedness plans should include mobile pro- visions, such as a 72-hour vehicle kit (“grab-n-go kits”), which includes shelter supplies. For example, backpack- ing tents are lightweight and convenient for emergency shelters. Other suggestions for items to include in personal kits can be found on the CDC web site (http://emergency. Natural Disaster and the Role of Public Health Nurse

cdc.gov/preparedness/kit/disasters) and FEMA’s “Ready. gov” (Table 1). In addition, disaster supply kits should be tailored to meet individual needs, including special dietary or health care needs. Kits kept in vehicles are sub- jected to extremes of temperature; items melt in extremes of heat and batteries are exhausted more quickly in the cold (solar flashlights and chemical light sticks work well in vehicles). For water purification, individuals can in- clude bottles with filters, iodine tablets, or a cup for boil- ing water before use. It is essential to update emergency kits with the season. Extra clothing, shoes, and blankets may be needed in winter months. Ice packs, umbrellas, and rain coats may be needed in summer months. Individ- uals should plan accordingly depending on the weather in their region. The CDC also recommends including tools, sanitation and hygiene items, personal documents, and first aid supplies. Ideally, homes should be stocked with enough supplies to last 1 to 2 weeks.

Once emergency kits are assembled, family mem- bers should design an emergency plan that includes alter- nate meeting places in case the disaster leaves the home uninhabitable and alternate means of communication in the event wired lines are severed and cellular service is down, a state of affairs that will be especially unbear- able for teenagers. If phone service is available, families should have a calling plan in place. An out-of-state con- tact should be chosen. One of the lessons learned from 9/11 and other disasters was that mobile lines are often overloaded in the midst of a crisis, but individuals may be able to send text messages or post communications via social media such as Facebook or Twitter. Further, the CDC suggests choosing two meeting places: one immedi- ately outside the home for sudden emergencies and a sec- ond outside of the neighborhood in case family members are unable to return home.

Evacuation routes should be thoroughly planned; rule #22 of Zombieland: “When in doubt, know your way out” (Polone & Fleischer, 2009). Families should con- sider how many bridges, overpasses, mountains, lakes, and rivers are part of their usual commute. Questions for reflection include, “Will rubble block the normal route of travel (as with an earthquake)?” “What alternate travel routes may be available?” Planning evacuation routes including alternate paths allows individuals and families to escape devastation and take shelter immediately. Fur- thermore, parents should know the emergency plans of schools their children are attending. In a major disaster, will the children be sheltered in place or will they be sent home? Preparations must also be made for pets, including food, medications, and shelter.

Finally, “disaster readiness behaviors” include keeping the vehicle gas tank above half full and check- ing house batteries for fire alarms and carbon monox- ide detectors every 6 months. Fire extinguishers should be checked on a monthly basis; they should be gently agitated to keep the chemicals mixed. Setting remind- ers on mobile devices may make these tasks easier to remember. During Hurricane Sandy, the most valuable tools were solar charging pads for mobile devices, tab- lets, and computers. Natural Disaster and the Role of Public Health Nurse

Disaster Readiness for Nurses in the Workplace Preparing for the Zombie Apocalypse

Draper Lowe, L., Hummel, F. I.

Workplace Health & Safety 2014;62(5):207-213.

1 As one of the largest bodies of health care providers in the nation, nurses are in a prime position to make substantial contributions to di- saster readiness at work, in the community, and at home.

2 Lessons learned from previous disasters should be considered when developing a disaster plan for the workplace.

3 Ethical-legal concerns encountered by nurses during disaster care include communication plans and expectations for participation.

I N S U M M A R Y

213WORKPLACE HEALTH & SAFETY • VOL. 62, NO. 5, 2014

CONCLUSION The chief obstacle to disaster preparedness is com-

placency and apathy. Obviously, nobody expects a zom- bie apocalypse. Disasters occur when hazards, natural and manmade, meet vulnerability. All communities are vulnerable. It is vital to be prepared on multiple levels (individual, family, workplace, and community) to suc- cessfully respond to an emergency event. Nurses working in a variety of settings have the opportunity and responsi- bility to participate in and promote disaster readiness ac- tivities. Nurses can become involved in community pre- paredness activities and increase their knowledge of and experience with disaster preparedness, including work- ing with organizations such as the American Red Cross, Medical Reserve Corps, and Community Emergency Re- sponse Team training and certification. During National Preparedness Month, nurses can encourage others to fol- low CDC recommendations and “Get a Kit, Make a Plan, Be Informed, and Get Involved!”

REFERENCES American Nurses Association. (2008). Adapting standards of care un-

der extreme conditions: Guidance for professionals during disasters, pandemics, and other extreme emergencies. Silver Spring, MD: Au- thor. Retrieved from http://nursingworld.org/MainMenuCategories/ WorkplaceSafety/Healthy-Work-Environment/DPR/TheLawEthic- sofDisasterResponse/AdaptingStandardsofCare.pdf

Bernard, M., & Mathews, P. R. (2008). Evacuation of a maternal-new- born area during hurricane Katrina. MCN The American Journal of Maternal Child Nursing, 33, 213-223.

Brewer, K. (2010). Who will be there? Ethics, the law, and a nurse’s duty to respond in a disaster. ANA Issue Brief. Retrieved from http:// www.nursingworld.org/MainMenuCategories/Policy-Advocacy/ Positions-and-Resolutions/Issue-Briefs/Disaster-Preparedness.pdf

Centers for Disease Control and Prevention. (2013). Be ready! Septem- ber is national preparedness month. Retrieved from http://www.cdc. gov/features/beready/

Centers for Disease Control and Prevention, Office of Public Health and Preparedness and Response (2013). Zombie preparedness. Re- trieved from http://www.cdc.gov/phpr/zombies.htm

Chamings, P. A. (2008). Is it professionally acceptable for a nurse to stay home during a pandemic? 2nd opinion: Writing for the pro po- sition. MCN The American Journal of Maternal Child Nursing, 33, 202.

Federal Financial Institutions Examination Council. (2012). Lessons learned from hurricane Katrina: Preparing your institution for a cat- astrophic event. Retrieved from http://www.ffiec.gov/katrina_les- sons.htm

James, D. C. (2008). Is it professionally acceptable for a nurse to stay home during a pandemic? 2nd opinion: Writing for the con position. MCN The American Journal of Maternal Child Nursing, 33, 203.

Lee, A. (2012, April). Twisting your disaster plan: Lessons learned from the April 27, 2011 Tuscaloosa tornado. Presented at: the 2012 Vol- unteer Symposium: Recovery, resilience, and hope after disaster. Symposium conducted in Montgomery, AL. Retrieved from http:// www.adph.org/ALPHTN/assets/2012VolSympLee.pdf

Polone, G. (Producer), & Fleischer, R. (Director). (2009). Zombieland [Film]. United States: Columbia Pictures.

Ripley, A. (2008). The unthinkable: Who survives when disaster strikes– and why? New York: Random House, Inc.

Schultz, R., Pouletsos, C., & Combs, A. (2008). Considerations for emergencies and disasters in the neonatal intensive care unit. MCN The American Journal of Maternal Child Nursing, 33, 204-210.

U.S. Department of Homeland Security, Federal Emergency Manage- ment Agency. (2013). FEMA: About the agency. Retrieved from http://www.fema.gov/about-agency

U.S. Department of Homeland Security, Virtual Social Media Working Group and DHS First Responders Group. (2013). Lessons learned: Social media and Hurricane Sandy. Retrieved from https://commu- nities.firstresponder.gov

U.S. Department of Labor, Bureau of Labor Statistics. (2012). The 30 occupations with the largest projected employment growth, 2010 to 2020 (table 6). Retrieved from http://www.bls.gov/news.release/ ecopro.t06.htm

Veneema, T. G. (2013). Disaster nursing and emergency preparedness: For chemical, biological, and radiological terrorism and other haz- ards (3rd Ed.). New York: Springer Publishing.

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