Disaster Management and Health Promotion

By: Andrea Smilski, RN, BScN, MBA BSN Program, Vancouver Island University

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Health Opportunities or Threats: Trends Worldwide

Emerging Public Health Threats Globalization Aging Society Public Health Infrastructure Changing Demographics Rising Health Care Costs Aging Workforce Information Technology Human Genome Weather Changes
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The World of Urgent Threats and Urgent Realities

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West Northeast Avian Nile Blackout Influenza Hurricanes Marburg Virus Aug 03 Jan-Mar Virus (Charley, Aug-Nov 02 04 Mar 05Frances, Anthrax Ivan, Jean) Sept Influenza Attacks Shuttle Tsunami Aug-Oct 04 Sept 03 Columbia Dec 04SARS Hurricane Disaster Influenza Feb 05 Mar-Aug 03 Wilma Guam Vaccine 2004 Oct 05Typhoon Shortage Monkey Summer Present Feb 04 Oct 04-05 Pox California Olympics Hurricane June-Aug 03 Wildfires June 04 West Oct-Nov 03 Hurricane Nile Virus Rita Tularemia Sept. 05 Isabel G8 Aug-Nov Anthrax present Sept 03 Summit 04 Oct-Nov 03

World Trade Center Sept 2001

Urgent Threats

Hurricane Katrina Aug. 05 present

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News

Heat wave-related deaths in France now estimated at 15,000

Last Updated Tue,

09 Sep 2003 19:23:38

News

Tsunami's toll leaps above 117,000

Last Updated Thu,

30 Dec 2004 18:57:03 EST

News

Death and destruction in Katrina's wake

Last Updated Wed,

31 Aug 2005 14:24:35 EDT

News

Earthquake death toll could top 54,000

Last Updated Mon,

17 Oct 2005 10:10:44 EDT

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Floods
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CN Derailment

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Bridge Collapse

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Anthrax on board

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Another plane down Biologics on board

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Canadian Prairie Hail

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Ice Storm
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Canadian Snow Storm

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Mass Casualties

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and then some

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Urgent Realities

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Global Health Challenges

World Wide Life Expectancy

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An Aging Population

Percentage of the population over the age of 65

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Global Challenges

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Health Promotion
Health promotion is the process of enabling people to increase control over, and to improve, their health (Ottawa Charter 1986).

Five

Key Action Areas: Build Healthy Public Policy Create Supportive Environments Strengthen Community Actions Develop Personal Skills Reorient Health Services
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Health Promotion
The fundamental conditions and resources for health are: Peace, Shelter, Education, Food, Income, A stable eco-system, Sustainable resources, Social justice, and equity
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What happens in a EmergencyMan made or Natural

Five Major Outcomes: Human Loss, Injuries Massive damage to infrastructure Population Displacement and dismemberment of the family fabric Economic hardships Intense Bereavement and Anger
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Loss of human lives/injuries

Immediate social and health needs. Psychological trauma Injuries (or injured) are not receiving quality treatment Loss of Human lives due to secondary causes of injuries Long-term disabilities

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Damage to infrastructure

Not only health facilities but infrastructure having tremendous impact on human health (water, housing, sanitation, etc) Existing mechanism of care is disrupted (family care, etc) Greater risk of epidemics Limited access of the relief agencies to affected population (damaged roads, insecurity, blockages, power plants down, no fuel, etc) Contamination (oil spillages, etc)
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Population Displacement
New habitats Strain on existing civic amenities Patients with chronic diseases become more vulnerable Sense of insecurity Loss of self esteem Refugees

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Economic Hardships
Loss of entrepreneurships Reliance on aid Increased dependency Vulnerability to ill-health and new diseases May lead to nonsocial behaviors and events

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Bereavement and/or anger

Psychologically and emotionally vulnerable May resort to bizarre behaviors May become unhappy with the response of the government and agencies Partly may be misinformation received through local media or other sources

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The Role of Health Promotion & Public Health Professionals

Organizing and Informing the community

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The phases of an emergency/disaster

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Unfortunately Emergencies/Disaster do not follow a linear course

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Importance of Health Promotion in Emergencies/Disasters

Emphasizing the public health impact of the issue. In the context of emergency/disasters management, HP involves working with people to prevent, prepare for, and respond to disasters to reduce risks, increase resilience and mitigate the impact of disaster on health. Community participation, therefore, is the basis of successful HP in such disaster situation
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The Importance of Community Participation in HP in a emergency/disaster situation

Emergency Prevention and Preparedness: Community participation in assessing risks and vulnerability; promoting awareness of environmental hazards and safety consciousness; strengthening community resilience and organization. Awareness raising and training are the cornerstones. Emergency response and recovery: community participation in the response phase in the immediate aftermath of disaster; ensuring sustainable and incremental improvements in environmental health
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Summary of the Role of Health Promotion Professionals in various phases

Preparedness
Organize community for making them health and safety conscious Define pop. at risk and their level of risk

Response
Provide how to information, promote awareness Specify the consequences of the condition and recommended action Adjustments of health promotion activities to prevailing health conditions and scarcities Need to deal with psychosocial problems of the situation Identification of specific messages and communication methods appropriate to the situation Provide training and guidance in performing action

Recovery
Gradual blending into more stable condition Assessment of individuals/ groups who may require long term care Ensuring that the rebuilding process is health focused

Tailor risk information based on an individuals characteristics Help the individual develop her/his own perception of risk Adaptation of methodologies to actual and potential needs Promoting good health practices in community development 3/23/2013

Use of messages based on problems/practices associated with recovery phase Psychological rehabilitation and long term support

Focus on disaster preparedness and prevention

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Its all about assessing and mitigating risks

Which specific practices are placing health at risks? Which is the most vulnerable group of population? What could motivate the adoption of safe practices? Who should be targeted by the program? How can one communicate with these groups?
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Coordination-the real challenge?

Duplication and wastage of scarce resources. Often community needs are not assessedthey receive the support we perceive they need not what their real needs are. Non-synthesis of information Donors driven agenda? Governments over-reliance on relief agencies.
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Some Critical Public Health Areas where health promotion professionals can play a critical role

Generating data and information on the effectiveness of interventions Environmental Hygiene (water, sanitation, housing, etc) Mental health promotion Immunization-Maternal and Child Care Prevention of epidemics Care of patients with chronic illnesses Calculating trends Engaging media as an active partner
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A Multilevel Approach to Epidemiology of Community Participation in Health Promotion

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Future challenges

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JURISDICTION

Lead Disaster Management Agency

Lead HEALTH Disaster Management Agency

Public Safety and Emergency Preparedness

Public Health Agency of Canada

Federal

Provincial

Emergency Measures Organization

BC Health Office of Disaster Management

Emergency Preparedness Program

RHA Disaster Management Program

Municipal
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Situating the Regional Health Authority

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TERTIARY HOSPITALS ACUTECARE HOSPITALS LONG TERM CARE CENTRES PERSONAL CARE HOMES COMMUNITY OFFICES FUNDED AGENCIES

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HOW IS THE RHA DISASTER MANAGEMENT PROGRAM SET UP TO PROVIDE PLANNING GUIDANCE TO SITES?

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Executive Management

Disaster Management Program

Regional Disaster Management Plan

Mitigation Preparedness Response Recovery

Advisory Committee
Task Sub-Committee

Facility/Community Disaster Management Plan Mitigation Preparedness Response Recovery Unit/Floor/Ward/Individual Task Sheet

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Regional Health Authority (RHA) and Incident Command System (ICS)

Corporate Acute Care Hospital Long Term Care Sector Community Sector

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 a flood destroys your home and office neighborhoods a new patient presents with a strange rash a cloud forms over the city and people are having difficulty breathing 10 of your reactive airway disease patients show -up at the office requesting treatment

two days ago a patient presented with flu-like symptoms, today four of your staff call in sick with similar symptoms
an explosion rocks your office, glass shatters into your waiting room, patients are thrown to the floor, equipment and pharmaceuticals fall from their shelves, your phone is not working, you realize that a bus has crashed into your building, there are 20 passengers on board with 15 of them suffering moderate injuries. The bus driver is pleading for your help.

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Mutual Aid Admitting privilege hospital is closed Credentialing Ethical and practical considerations

Communications Who speaks to whom How are you communicating Media New Duties Obligations Health Authority ICS

Challenges Barriers Obstacles or Opportunity

Your role

Liability Remuneration

Non-traditional setting
Altered standard of care

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Thinking about and planning for disasters is not as painful as having to explain why we didnt.
Source obscure.
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