All hospitals are required to have a comprehensive disaster management plan which is aimed to minimize deplorable consequences (e.g. disruption of patient care, physical damage to the building, injured and killed people, etc.) of a disaster by specifying the course of action a facility should take to respond and recover from an emergency regardless of its nature (Usher et al., 2015). The nurse plays one of the major roles in assessing and increasing the effectiveness of the emergency plan as he/she is involved in the management of all possible kinds of disasters including tornadoes, hurricanes, fires, floods, droughts, earthquakes, landslides, terrorist attacks, etc. and contributes to a positive outcome of the recovery process (Cherry & Jacob, 2016). The paper at hand is going to dwell upon the content of the disaster plan as well as the role of health care staff in its activation.
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Activation of the Plan
Before approving the plan, it is essential to identify who is going to be involved in the implementation process at all levels of the facility’s organization. The activation team should consist of (Dolan & Holt, 2013):
- the disaster management body (which can be Incident Command System, Hospital Emergency Committee, etc.) featuring a comprehensible structure, high flexibility allowing to deal with both minor and severe accidents, non-interrupted reporting line, clear-cut division of duties, well-defined goals, and a designated leader (Incident Commander);
- providers of essential services (such as suppliers of water, food, electricity, medications, waste collectors, etc.)
- functional teams with clear responsibilities in such areas as infection control, clinical care, security provision, logistics, information, physiological help, social interactions, etc.; to control the activities of the teams, it is recommended to appoint officers in each section (Information Officer – responsible for the spread of data, Safety Officer – managing developing hazards, Liaison Officer – ensuring coordination of different agencies, etc.)
- teams responsible for relations with media through various communication channels; the teams are supposed to develop effective strategies to establish connections with health authorities;
- control team responsible for monitoring the implementation of the plan and evaluating its effectiveness and compliance with control protocols;
- psychological support team responsible for the provision of psychological services to victims and their relatives.
The plan is activated through the following steps (Stanhope & Lancaster, 2015):
- assessing the situation (the gravity of the disaster, preparedness of the plan, health care facilities, etc.);
- clarifying national and local policies connected with disaster management (identifying emergency preparedness of the region, mechanisms of coordination with all the key stakeholders, supply distribution plan, etc.);
- adapting the framework of disaster preparedness to the local conditions (applying national policies and existing guidelines to the actual situation);
- establishing all the required teams for health care and supplies provision, information dissemination, security control, etc. (selecting people with an appropriate level of knowledge and skills in disaster preparedness);
- planning at each facility (ensuring participation of the community and stakeholders);
- compiling preparedness plans both at the local and national levels (integrating plans to come out with practical guidelines);
- monitoring the implementation of the plan (ensuring feedback and support revisions of the disaster site).
Criteria to Establish the Command Center
The first step of the disaster plan implementation is the establishment of the command center. Before identifying where it should be located, it is necessary to divide the space into three zones: 1) hot zone (a hazardous closed area where the disaster occurred); 2) warm zone (a less dangerous area accessible to the personnel); 3) cold zone (a relatively safe part of the site) (Rokkas, Cornell, & Steenkamp, 2014).
The command center should be located upwind and upstream of the hot zone in the cold zone to be accessible for supply providers and the media. The distance between the center and the hot zone should be determined by the conditions specific to each particular emergency (Maurer & Smith, 2013). The establishment of the command center concerning the disaster site should align with the following criteria (Nies & McEwen, 2014) :
- physical and topographical characteristics of the area;
- the weather and direction of the wind;
- the amount of air and land contaminants;
- the presence of various chemicals and their characteristics (physical, toxicological, etc.)
- accessibility for transportation systems;
- potential threats (fire, explosion, flood, etc.)
- power and water sources.
Communication of the Plan to the Staff
After the emergency response program has been launched, the health care staff must be immediately informed about the plan for further actions and their responsibilities in its implementation. The following recommendations may help communicate the plan to internal and external stakeholders (Berkes, & Ross, 2013):
- stakeholders must be informed via email or telephone before a personal meeting to have time to get acquainted with the emergency plan;
- each member of the staff should be aware of the plan and ways it is going to affect him/her individually;
- a comprehensible protocol of communication must be established (e.g. regular email updates or meetings);
- credible sources should be identified and resorted to for the staff to be sure that the information they receive is up-to-date;
- all accessible information channels must be used (bulletin boards, internet, phone, etc.);
- any changes in the plan need to be communicated to all stakeholders as soon as possible.
When the plan has been debriefed or called off, it is important to ensure feedback from stakeholders. Staff members and external stakeholders should discuss how well they managed to act under pressure, what mistakes were made, which parts of the plan were especially successful, and which require further improvement, etc. (Schneider, 2016).
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Potential Threats to Quality Care Delivery in a Disaster
The following threats can undermine the quality of health care provision (Schneider, 2016):
- lack of personnel (few professional doctors and nurses and too many people needing help);
- insufficient water or food supplies (may be caused by the nature of the region or its economy);
- interruptions of the supply chain (problems with transportations or roads after the disaster);
- low-quality resources;
- poor qualifications of the staff;
- weather conditions (some natural disasters are followed by climatic changes);
- lack of communication with local authorities (lack of initiative on their behalf);
- the reluctance of the population to go into contact (distrust for cultural reasons);
- lack of space in hospitals.
Measures and Suggestions
The following measures are implemented in the plan to ensure that quality care is administered (Allender, Rector, & Warner, 2013):
- disaster preparedness teams encourage feedback from the population to make sure that all the needs are satisfied;
- essential services are prioritized to prevent aggravation of the situation;
- the staff is tested for having all the required skills;
- potential problems are discussed and addressed in advance;
- all the actions of the personnel are monitored and assessed using checklists;
- the plan is reviewed in case any changes occur.
It can be suggested to:
- support the connection with federal authorities in case of lack of resources;
- develop plan B to be prepared for a possible failure of plan A;
- encourage cooperation with the community;
- launch volunteering programs to obtain extra staff;
- collaborate with charity organizations;
- attract investors that can advertise their services donating money for disaster victims;
- relocate victims to the other region in case hospitals are full;
- increase awareness of the population of the possible emergencies in the area.
Allender, J., Rector, C., & Warner, K. (2013). Community & public health nursing: Promoting the public’s health. Baltimore, MD: Lippincott Williams & Wilkins.
Berkes, F., & Ross, H. (2013). Community resilience: Toward an integrated approach. Society & Natural Resources, 26(1), 5-20.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. New York, NY: Elsevier Health Sciences.
Dolan, B., & Holt, L. (Eds.). (2013). Accident & Emergency: Theory and Practice. New York, NY: Elsevier Health Sciences.
Maurer, F. A., & Smith, C. M. (2013). Community/public health nursing practice: Health for families and populations. New York, NY: Elsevier Health Sciences.
Nies, M. A., & McEwen, M. (2014). Community/public health nursing: Promoting the health of populations. New York, NY: Elsevier Health Sciences.
Rokkas, P., Cornell, V., & Steenkamp, M. (2014). Disaster preparedness and response: Challenges for Australian public health nurses. Nursing & Health Sciences, 16(1), 60-66.
Schneider, M. J. (2016). Introduction to public health. Burlington, MA: Jones & Bartlett Publishers.
Stanhope, M., & Lancaster, J. (2015). Public health nursing: Population-centered health care in the community. New York, NY: Elsevier Health Sciences.
Usher, K., Redman-MacLaren, M. L., Mills, J., West, C., Casella, E., Hapsari, E. D.,…Amy, Y. Z. (2015). Strengthening and preparing: Enhancing nursing research for disaster management. Nurse Education in Practice, 15(1), 68-74.