Best Practices for Disaster Preparedness

2014 - 6 December - Disaster Management
Kate Moore, DNP, APRN-BC, CNE, FCCM
Kate Moore, DNP, APRN-BC, CNE, FCCM, examines best practices for disaster preparedness.

They say the best offense is a good defense. That is essentially the rationale behind disaster preparedness. Placing a premium on disaster-response training and education and having protocols and policies in place beforehand are crucial to mitigating a disaster’s impact. This holds true for both infectious disease outbreaks (e.g., Ebola, avian influenza, Middle East respiratory syndrome, coronavirus) and natural disasters such as earthquakes, hurricanes, tornados, and tsunamis.

Disease Outbreak Preparedness

The first step in disease outbreak preparedness is ascertaining broad-based knowledge about potentially threatening infectious diseases. For instance, medical personnel need to understand how various diseases are contracted. By way of example, hepatitis C -- a blood-borne pathogen -- spreads very differently than anthrax. Equipped with this knowledge, medical personnel can better protect themselves from contracting such diseases in the event of an outbreak. They can also educate the public should an outbreak materialize, which is crucial to halting the spread of misinformation and panic. Healthcare institutions should make certain education programs are in place (or made available to workers) to ensure the dissemination of appropriate knowledge.
 
In addition to general education, ongoing training should also be prioritized to prepare medical personnel to manage disease outbreaks. In a 2013 review of disease outbreak preparedness among critical care nurses, a list of recommendations were provided.(1) These recommendations included, but were not limited to, the following:

• Ongoing training related to the principles of quarantine and isolation, routes of transmission and general infectious disease prevention and control
• Training on protocols for the care of pediatric and geriatric populations
• Simulations of high-risk, low-volume scenarios that integrate the proper use of personal protective equipment
• Use of best practices of education that include debriefing and teach-back models of evaluation
• Ongoing education and evaluation programs to maintain currency with evidence-based practice related to infectious disease outbreaks

The U.S. military adheres to a policy of “train like you fight.” Medical personnel should do likewise when preparing for a potential disease outbreak. Doing so will increase aptitude, boost practitioner confidence and, ultimately, improve performance.

Preparing for Natural Disasters

While infectious disease outbreaks generally have a point of origin, a patient zero and a tendency to build with intensity as the cohort of infected individuals increases to epidemic or pandemic levels, natural disasters come with little or no warning. The increased ability to accurately predict storms has facilitated preparedness for hurricanes, tornados and other weather-related disasters. However, some natural disasters, such as earthquakes, generally strike without warning, leading to a disruption of communication capabilities and impeded access to services. Responders often face difficulties safely accessing those in need.

Once again, comprehensive planning, training and education are crucial. So, too, is the ability to build surge capacity.(2,3) Similar to infectious disease outbreaks, proper preparation can significantly mitigate the impact of a meteorological disaster.

Challenges, of course, are abundant. It is difficult to test your level of preparedness until a disaster occurs. Until that time, it is problematic to accurately estimate the extent of the disaster or the number of potential victims. Also, keep in mind that the stockpiling of supplies and equipment is limited by space and expiration, and some of the most critical commodities -- like medications and blood -- have a limited shelf life. Likewise, there is also a shelf life for education and training, as skills degrade without use.(4) Nevertheless, a preparedness regimen similar to that used for disease outbreaks can be highly beneficial.
 
Summary

Medical personnel face myriad challenges when responding to disasters.  Comprehensive planning, training, and education, however, can better prepare them to meet those challenges. We must therefore place a strong emphasis on this crucial trifecta, integrating the many lessons we have learned from disasters such as the recent Ebola outbreak, the anthrax scare of the previous decade, and the September 11, 2001, terrorist attacks.

References:

1. Makamure M, Makamure M, Mendiola W, Renteria D, Repp M, Willden A. A review of critical care nursing and disease outbreak preparedness. Dimens Crit Care Nurs.  2013 Jul-Aug 2013;32(4):157-161.
2. Gebbie KM, Qureshi K. Emergency and disaster preparedness: core competencies for nurses. Am J Nurs. 2002 Jan;102(1):46-51.
3. Milsten A. Hospital responses to acute-onset disasters: a review. Prehosp Disaster Med. 2000 Jan-Mar;15(1):32-45.
4. Williams J, Nocera M, Casteel C. The effectiveness of disaster training for health care workers: a systematic review. Ann Emerg Med. 2008 Sep;52(3):211-222, 222 e211-212.