Personal Preparedness for Public Health Workers
Tennessee Public Health AssociationAnnual MeetingAugust 2008
Susan Speraw, PhD, RNAssociate ProfessorThe University of Tennessee College of NursingKnoxville
Hurricane Katrina ~ 3 years ago
August 26, 2005
August 29, 2005
“Preparedness”: What is it?
• Assessment, critical thinking, priority-setting, teamwork
• Supplies / Equipment• Policies & Procedures• Drills / Training
/Practice• Contributes to
prevention, response, mitigation
• The concept applied differently to individuals and institutions– Readiness to
respond to bioterrorism
– “All hazards”• Goal to save lives
– “reverse triage”• Interdisciplinary
Preparedness
“Comprehensive knowledge, skills, abilities, and actions needed to prepare for and respond to threatened, actual, or
suspected chemical, biological, radiological, nuclear or explosive
incidents, man-made incidents, natural disasters, or other related events.”
Slepski, L. (2005). Emergency preparedness: Concept development for nursing practice. Nursing Clinics of North America, 40 (3), 419-430.
Why preparedness matters
• Ethical responsibility to care /duty– Whether employer– Whether employee
• We love our families• Self preservation
– Physical well-being– Emotional well-being
• Passive “preparation” doesn’t work• Denial has limits• Fear diminishes effectiveness
Why preparedness matters
• Disaster– The nature of skill sets required
• At variance with basic professional education• Scope of practice
– Shift in thought process• Who do we attempt to save?• Utilization of resources• Standard of care
– Diminished or absent situational / family supports & patterns of behavior
– Altered infrastructure– Profound ethical issues
Question…..
• Honestly……
Would YOU go to work if disaster struck?
What kind of disasters WOULD you respond to ?
What kind of disasters would you NOT respond to?
What research tells us
• Persell & Young (Arkansas State University)
• Study #1 (Preparedness / Knowledge base) (2004)
– 1000 health workers» 80% unable to answer more than 1 item correctly
about bioterrorism response
• Study #2 (To work or not to work) (2005)
– 95 senior nursing students– Reluctance to work in disaster– Fear for families
» Families were greatest factor– Had done nothing to prepare for families
Nurses in Community Health Centers
• Ablah, Tinius, Horn, Williams, Gebbie (2008)
– Nationwide CHCs serve approx. 16,000,000 persons in 5,000 locations in USA.
– Focus groups with medical directors of community health centers in New York City
• Providers reported much interdisciplinary training– Problems identified
• Overwhelming time demands for training• Staff without “instinct for emergency”• Teaching roles specific for disaster / chain of command• How to protect self and family• Preference for communication and information role in disaster
response, yet fear being drawn into acute role
Nurses in Katrina & Others
• Slepski (2007)– 200 health professionals across disciplines
• First time, Moderate (2-4), Very Experienced (5+)• Most deployed as part of teams
– “First time” Recommendations• Stressed personal preparedness
– Expectations» Work conditions» Professional duties (“primal”)» Personal supplies
– Ensuring that families also prepared & safe– Self care (don’t become another patient)
Slepski (2007)
• “Moderate” Recommendations• Team / group dynamics• Self care• Extraordinary training needs (beyond ACLS)
– BDLS / ADLS
• “Very experienced” Recommendations• Chain of command• Bureaucratic issues (red tape)• Interpersonal relationships• Communications• Work according to strengths vs. usual role• Group training
The Katrina Experience
• Reflections from Nurses– “Nursing in hell” (Jordan-Welch, UT Dissertation, 2007)
• “Tell me about your experience of giving care during Hurricane Katrina.”
– Lack of institutional preparedness– Lack of personal preparedness
» Unimaginable horror» Concern for families» Emotional trauma
– Lasting consequences» PTSD» Loss of confidence» Awareness of risk» Departure from health professions
Stories from the nurses
• Watching alligators and sting-rays swimming outside the windows
• Carrying 300 lb people up and down stairwells in hundred-degree heat, and down again when rescue never came
• No ventilation• Doors chained shut• Unable to “nurse” as accustomed & “right”• No running water, plumbing, food, sleep• Believing they had been abandoned
Katrina Experiences ~ Positives
• What helped people endure– Having families cared for reliably– Having contact with family– Spiritual support /chaplains– Support of peers (talk time, privacy)– Feeling safe in the environment– Having respite– Sufficient food and water– Realistic expectations
Lessons from “Nursing in hell”
• Our imagination cannot envision “disaster” effectively
• No amount of preparation is too much• Inadequate preparation….
• leaves lasting emotional trauma– weakens families who may break due to stress
• robs professionals of their self confidence• destroys confidence in institutions• reduces our workforce unnecessarily• costs lives
• It is possible to modify risk
What is missing in research
• Specifics of personal / family preparation– How to come up with a plan
– “hand holding”
– Emotional support for the plan implementation• Emotional preparation
– Trauma recovery• Responsibility of employers
– For training– For family preparation– For family care
The “bottom line”
• Disaster-specific Skills• Knowledge helps diminish anxiety• Practice prepares for role adjustment
• Personal/Family Disaster Plan• An issue for EMPLOYERS as well as
PROVIDERS
Disaster-specific Skill Training• National Disaster Life Support Foundation
• AMA roots• All Hazards approach• Core Disaster Life Support (CDLS)
– Support staff (security, housekeeping)• Basic Disaster Life Support (BDLS)
– Direct care providers in any role (direct client interaction)– Classroom (1 day)
• Advanced Disaster Life Support (ADLS)– Classroom and Field training (scenarios)
» Not tabletop» 2 days » BDLS is pre-requisite
– For health professionals (MD, RN, EMT, Vet)• Instructor Disaster Life Support
– 1 day– Requires ADLS
“Real life” kit assembly
• 2007-2008 Class assignment– Evaluate / critique preparedness websites:
• www.fema.gov• www.redcross.org• www.prepare.org (also ARC)• www.bt.cdc.gov/planning (CDC)• www.ready.gov (DHS)
– Problems:• How do you find them?• Radically different materials/information even from
same organization (ARC)
Using www.fema.govDisaster Information
Plan Ahead Apply for Assistance
Recover & Rebuild
About Us
Determine Risk?
Plan for Emergencies?
Assemble Supplies **
Basic Disaster Supplies•Water, Food, First Aid, Clothing, Bedding, Sanitation, Tools, Special Items (Baby, Adults, Cash, Documents, EntertainmentKit locations (3)Work/Home/CarMaintenance
From www.fema.gov
WaterHow Much Water do I Need?How Should I Store Water?
If You are Preparing Your Own Containers of WaterFilling Water Containers
How Much Water do I Need?You should have at least a three-day supply of water and you should store at
least one gallon of water per person per day. A normally active person needs at least one-half gallon of water daily just for drinking.
Additionally, in determining adequate quantities, take the following into account:Individual needs vary, depending on age, physical condition, activity, diet, and
climate. Children, nursing mothers, and ill people need more water.
Very hot temperatures can double the amount of water needed. A medical emergency might require additional water.
FEMA Critique
• Never mentions communication• Never discusses family reunification plan• Never discusses special needs• Cost never discussed• Storage not realistically discussed
– Weight, space
Using www.redcross.orgDisaster ServicesPreparedness Prepare at
homeBasic Disaster Supplies•Water, Food, First Aid, Clothing, Bedding, Sanitation, Tools, Special Items (Baby, Adults, Cash, Documents, Entertainment
Maintenance
Blood Services
Military Members & FamiliesHealth & Safety
Red Cross Critique
• Does mention sheltering in place• Does discuss communication plan• Does discuss evacuation plan• Does have an emergency communication card• Does discuss special medical conditions~~~~• Very confusing• Cluttered• Cost never mentioned• Storage not realistically discussed
Using www.prepare.org
• Also a Red Cross site– No similarity to www.redcross.org
• Not in content• Not in clarity
– Geared to families and communities– Does address disability explicitly
• Includes physical and mental– Does address senior citizens specifically– Multiple language options– Large print options– No cost analysis
Using Ready.gov
• Confusing for some– Some required 3-4 efforts to navigate the site– Order of steps not conducive to understanding:
• Get a kit; Make a plan; Be informed• Does address high rise buildings/apartments• Does talk about sheltering in place• Has handouts to print• No reference to pets• No mental health guidance• No cost discussed• No realistic storage requirements• No large print or foreign language options
Using TNEMA.gov
• All students found it “completely unsatisfactory”• At www.tennessee.gov
• No link to preparedness• Must go to alphabetical directory under “E” (emergency)
– www.tema.org (Tubular Exchanger Manufacturers Association) with no referral to TNEMA
– www.tema.gov (no such web page)– At www.tnema.gov
– Little information on disaster planning– Content that is there is “antiquated and inaccessible”– Readers encouraged to read State Hazard Analysis (but
cannot get to it)– Under the Planning tab, there are links to documents, but
none are functional
“Cost of Family Preparation”
• Average cost per person: $500• Not including “special needs” items such as
medications, equipment• Replacement every 6 months
• Time to gather: weeks
• Storage:• Weight issues• Space issues
Personal Experiences
Discussion
Where to go from here
• Peer support– Planning groups– Establish relationships for support before the event
• Staged family planning– Begin with essentials
• Engage employers• Know what’s coming in terms of their plans for family• Participate in disaster planning• Open “safe” discussion of concerns
• Training beyond drills• Emotional support
– Engage all service providers
Future
• Higher Education (degrees, certification)– Health providers in positions of high
leadership• Homeland Security Programs at University of Tennessee
– MSN– PhD– Interdisciplinary Certificate
• MPH programs• Disaster Management• Combination/joint or dual programs (MPH. MBA)
– Employers supporting/ facilitating pursuit of advanced education
Susan Speraw, PhD, RNDirector & Coordinator
Homeland Security Nursing ProgramMSN & PhD in Nursing
and Interdisciplinary Certificate
[email protected](865) 974-7586
