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Issues up close – Preparing for the worst is the key to surviving disasters


September is National Preparedness Month: a time for the nation and all nurses to analyze their ability to respond and find ways to advocate for individual, community, and national preparedness.

All disasters are local. Most—whether natural or man-made—are likely to affect smaller regions or even individual localities, such as the rash of deadly tornadoes in the spring of 2011 that hit Alabama and Joplin, Missouri. It’s important to remember that disaster situations don’t always make headlines; they can be as small-scale as a violent summer thunderstorm or an unexpected flash flood. Luckily, when local communities are prepared for the worst, they can more easily respond and ultimately recover from these situations. To this end, September is National Preparedness Month: a time for the nation and all nurses to analyze their ability to respond and find ways to advocate for individual, community, and national preparedness.

Local communities need a strong national framework if they are to be prepared and resilient. Recently, several important national-level activities have constructed a framework to help local communities better prepare for, and respond to, disasters.

The first national activity is key legislation that guides many federal activities around medical and public health preparedness. However, this law—the Pandemic All-Hazards Preparedness Act of 2006 (PAHPA 2006)—expires in 2011. So in order to maintain many national preparedness programs, Congress will need to act to replace this legislation. Rep. Hal Rogers (R-KY) has introduced bill H.R. 2405, the Pandemic All-Hazards Preparedness Reauthorization Act of 2011 (PAHPA 2011), which renews certain provisions of the original law, which ANA supports (alongside other nursing, medical, and public health organizations). Through support for this bill, ANA continues to advocate for a strong public health and emergency response framework, especially as it pertains to PAHPA 2011.

The bill provides funding for key parts of the federal planning and response efforts that include programs that develop what are known as countermeasures—medications, vaccines, equipment, and other technology used to prevent or treat a health threat, such as a biological weapon attack. The bill further requires certain regulatory and coordination functions around countermeasures, such as better coordination between the Department of Health & Human Services (HHS) and the Food and Drug Administration when countermeasures are developed, tested, and approved for an emergency. The need for these coordination efforts came to light during the 2009 H1N1 pandemic, when vaccines and other equipment were needed urgently but issues with regulatory process impeded getting them into practice quickly.

PAHPA 2011 also extends funding to programs run by the Office of the Assistant Secretary for Preparedness and Response (ASPR). The office of the ASPR reports directly to the Secretary of HHS, and guides and implements many national strategies concerning health preparedness. One such program is the Emergency System for Advanced Registration of Volunteer Healthcare Professionals (ESAR-VHP), which helps to coordinate a way for nurses and other health workers to register to become responders during a disaster. Predisaster registration is crucial, because volunteer responders need
to be credentialed, trained, and deployed formally in order to ensure that they have the skills and the personal protection to provide care in a disaster. ESAR-VHP helps volunteers find the best type of agency for their desired level of response—from the rapid deployment of a disaster medical assistance team (DMAT) to supporting a local community response through the Medical Reserve Corps.

Another key program under ASPR (and funded through PAHPA 2011) is the Hospital Preparedness Program (HPP). Under this program, HHS (through the Office of the ASPR) issues grants to states, territories, and municipalities to develop and test their capacities to handle a medical surge during an emergency. For example, according to HHS, the state of Missouri used HPP funds to purchase a mobile medical unit, which it was then able to deploy to provide medical care after the devastating tornado in Joplin. Overall, HPP reports that its program is successful. In its May 5 report to Congress, HHS reported state-by-state on the program highlights, and overall found that 76% of hospitals participating in HPP met 90% or more of all program measures for all-hazards preparedness in 2009.

Mixed reviews and gaps in the safety net

Despite the success reported by the federal government, other analyses of the state of the nation in terms of preparedness are not as glowing. In February, the Trust for America’s Health, an advocacy group that reports on public health priorities, released its annual report, Ready or Not?, an assessment of the nation’s ability to respond to emergencies or other health crises. The report documented some weaknesses at the state and national levels, particularly the substantial decreases in public health funding over the past 2 fiscal years. The report also found major gaps in the public health workforce, medical surge capacity, surveillance, community resilience, and vaccine and pharmaceutical research and development. The report urges federal and state action to remedy these issues, stating that “the economic situation is putting almost a decade of gains at serious risk.”

The lack of recognized crisis standards of care is a gap that is often not as widely recognized as hospital capacity or funding. This is of particular concern for nurses, as they potentially could be providing care in a disaster situation, whether part of their routine practice or as volunteer responders. In a disaster, a scarcity of resources—staff, medication, even life-saving equipment—can result from a mass-casualty situation or from physical destruction of a facility, which is what happened in Joplin. Several national professional groups are helping to close this gap. A 2009 Institute of Medicine (IOM) report, which ANA helped author, outlined some of these issues, but progress has been slow. ANA is again engaged with the IOM committee to draft a follow-up report on how to develop and implement
robust crisis standards of care and to support the health professionals who will need them in practice.

It is impossible to prevent all disasters, but we can prepare for all of them. Efforts must continue to provide coordination, planning, training, and community resiliency at all levels, in all sectors, and for all people. By being prepared, we can help communities respond better, recover faster, and rebuild stronger. For more information on disaster preparedness, go to

Katie Brewer is a senior policy analyst at ANA.

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