Disaster management & response : DMR : an official publication of the Emergency Nurses Association最新文献

Objective

To identify the health needs of patients with chronic diseases who lived through the great Hanshin earthquake of 1995.

Methods

Twenty-nine patients with rheumatism, diabetes, or chronic respiratory disease were enrolled in the study. Semi-structured interviews were performed by the authors in 2004.

Results

Priorities for patients with all three diseases were securing medications and ensuring that they were able to take their medications. Rheumatism patients required methods of preventing their bodies from becoming cold, fatigued, and stressed in order to prevent aggravation of their disease; they also wanted relief workers to understand the physical limitations they experience. The health needs of diabetic patients included receiving an appropriate diet and developing ways to cope with the stress caused by the change in living environment. Patients with chronic respiratory diseases reported that their health needs included developing methods to prevent their bodies from becoming cold, fatigued, and stressed in order to prevent aggravation of their disease, access to respiratory masks to minimize dust and cold air exposure, and guidance in methods to alleviate respiratory symptoms.

Conclusions

The emergency preparedness planning and care priorities for individuals with chronic health problems, such as rheumatism, diabetes, and pulmonary disease, should include attention to medication availability, stress management, support for activities of daily living, appropriate food, and availability of support devices necessary to minimize exacerbation of symptoms.

Although disaster preparedness and mock disasters are common, the unique results that occur from the planning, implementation, and evaluation of a mock disaster are seldom mentioned. A school of nursing within a small, private university located in eastern Kentucky formed new partnerships with the community as a result of completing a practice drill. The drill served to form a working relationship between the university and the community, which had often viewed the university as isolated. A description of the mock disaster and benefits are presented.

Bioterrorism represents a threat for which most emergency departments (EDs) are ill prepared. In order to develop an evidence-based plan for ED and hospital management of contaminated patients, a review was conducted of the most effective strategies developed during the severe acute respiratory syndrome (SARS) epidemic, as well as Centers for Disease Control and Prevention and military guidelines on biowarfare. Six basic steps were identified: 1) lock down the hospital and control access to the ED; 2) protect emergency care personnel with appropriate personal protective equipment; 3) decontaminate and triage patients; 4) isolate patients; 5) treat patients with appropriate medications or measures, including decontamination of wounds; and 6) use restrictive admission and transfer guidelines. By emphasizing these six basic concepts, a rural ED passed an annual state-run bioterrorism mass-casualty drill. The drill provided health care personnel with the knowledge and skills necessary to prepare for future bioterrorism casualties. These same concepts could also be used to manage highly virulent viral or bacterial outbreaks.

When major disasters incapacitate hospitals and definitive care facilities—as Hurricane Katrina did in 2005—a crisis point is rapidly reached. Critical care services are often the first to be overwhelmed. Personal experiences and regional disaster plans were examined in the wake of Hurricane Katrina to uncover shortfalls in delivery of care and resources. A search was undertaken for a viable model for delivering critical care services in the immediate post-disaster period. Such a model already exists in the US Air Force's (USAF) Critical Care Air Transport Teams (CCATT). These teams have functioned well during recent military conflicts by providing both ground critical care and transport of high-risk, severely injured patients. The need for augmented critical care and transport resources in the face of overwhelming casualties in the civilian environment does not require a de novo construct. The USAF's CCATT model should be easily adaptable to the civilian disaster scenario.

Local public health authorities (LPHAs) are recognized as playing critical roles in response to biological, chemical, and other health emergencies. An influx of emergency preparedness funding has created new and expanding responsibilities for LPHAs. Concern that funding for emergency response is diverting attention and resources away from other core public health responsibilities is increasing. In order to determine the impact of emergency preparedness funding on public health infrastructure, qualitative interviews with 27 LPHAs in the metro-Boston area were conducted as part of an on-going evaluation of preparedness planning in Massachusetts. Feedback on the benefits and challenges of recent emergency preparedness planning mandates was obtained. Benefits include opportunities to develop relationships within and across public health departments and increases in communication between local and state authorities. Challenges include budget constraints, staffing shortages, and competing public responsibilities. Policy recommendations for improving planning for emergency response at the local level are provided.