Disaster management: Nursing

Nurse Judy is working in the pediatric intensive care unit when she feels the ground start to shake beneath her feet. She looks around at the faces of her colleagues on the unit who appear confused and a bit afraid. The shaking lasts 10 seconds and then the unit clerk asks, “Was that an earthquake?” Nurse Judy responds, “I’m not sure. I’ve never been in an earthquake before.” Within minutes, the charge nurse is notified that there has been an earthquake and that the disaster management plan has been initiated.

A disaster, or mass casualty event, is when illnesses or injuries exceed the resources or capabilities of a healthcare facility or a community. Disaster management, also called emergency preparedness and response, is the planning and actions taken by the healthcare team to decrease the potential for harm during a disaster.

Now, disasters can be categorized as both internal and external. An internal disaster takes place within the facility and can include fires, hurricanes, explosions, violence in the facility, or loss of critical utilities like water or electricity. These types of disasters may require evacuation of the facility.

On the other hand, external disasters occur outside of the facility. These disasters can be natural or man-made. Natural disasters include weather-related events such as hurricanes, tornadoes, earthquakes, like at Nurse Judy’s hospital, or pandemics. Man-made disasters, also called technologic disasters, include events like a nuclear reactor malfunction or terrorism which can include nuclear, biologic, or chemical sources of terrorism. At times, special considerations, like decontamination and containment, must be taken for nuclear, biologic, or chemical disasters. In some cases, a disaster can be considered both internal and external, like when a hurricane results in loss of critical utilities at a hospital and also casualties in the community.

Most healthcare facilities have their own disaster management plan which involves many members of the interdisciplinary healthcare team. The first-responders at the scene, like firefighters and emergency medical technicians, typically move people away from danger, rapidly triage victims at the site of the disaster, and transport them to the hospital.

Within the healthcare facility, there are various leadership roles on the disaster management team who help to oversee the response to the disaster. This includes an incident commander who assumes overall leadership, a medical command physician who helps determine needed resources and staff, a triage officer who triages clients as they arrive at the hospital, and other officers who are in charge of supplies, communication, infection control, and community relations. In addition, nurses, physicians, nurse practitioners, nurse’s aides and many other healthcare team members serve a critical role by providing care to the victims coming in as well as continuing care for the clients already in the hospital.

Now, there are several phases in an institution’s disaster management plan which include a mitigation and preparedness phase, response phase, and a recovery phase, and you, as the nurse, will take part in each phase.

Before a disaster occurs, in the mitigation and preparedness phases, you can help to develop internal and external response plans and participate in training drills that help to test the plans and simulate real disasters. Most importantly you should understand your role in the event of a disaster before a disaster has occured. Now back to Nurse Judy. Before the incident happened, she had participated in two disaster training drills since joining this hospital two years ago. She knows who the incident commander is and understands her role in the event of an emergency which is to remain in her unit and provide care to the incoming clients.

During the response phase, which is during or immediately following a disaster, you should follow the disaster management plan and begin functioning in your designated role.