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Clinical Spotlight
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
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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
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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 and disclosures are available at
www.sccm.org/criticalconnections.
Kate Moore, DNP, APRN-BC, CNE, FCCM, is an associate
professor of nursing at the Nell Hodgson Woodruff School of
Nursing at Emory University in Atlanta, Georgia, USA. She
retired from the U.S. Army Reserve, Army Nurse Corps, at
the rank of colonel after 22 years of service and multiple
deployments to austere environments.
Critical Connections