© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Session 4 – Lesson Seven
Public Health and Population
Health in Disasters
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Learning Objectives
Discuss emergency public health response actions that can be
implemented in a disaster
Discuss health issues that need to be addressed in all-hazards
disaster preparedness and response planning
Explain the rationale for a function- and access-based
definition to address all individuals who may be more
vulnerable to adverse health effects in a disaster or public
health emergency
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Learning Objectives
Describe pediatric vulnerabilities and challenges that need to
be addressed in all-hazards disaster preparedness and
response planning
Discuss the potential impact of disasters on individuals with
chronic illnesses
Discuss mental and behavioral health consequences for
children and adults affected by a disaster or public health
emergency
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Definition of a Public Health System
A complex network of individuals and organizations that,
when working together, can represent what we as a society
do collectively to ensure the conditions in which people can
be healthy.
Institute of Medicine (IOM), 1988
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BDLS® v.3.2
Public Health System Basics
Function:
– Protect populations against
injury, disease, environmental
and occupational hazards
Workforce:
– Diverse skill sets, backgrounds,
and experience
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BDLS® v.3.2
Large-Scale Disasters
and Public Health Emergencies
• Damage to public health infrastructure
• Widespread population displacement
• Health service disruption
• Population resource disruption
• Critical: Integration of public health and emergency care system
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BDLS® v.3.2
Shift in Perspective
Jocelyn Augustino/FEMA Andrea Booher/FEMA
Individual Population
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BDLS® v.3.2
Public Health Functions in Disaster
Promote health and hygiene, prevent Provide supply of food, clean water, sanitation
epidemics and spread of disease supplies
Conduct mass vaccination/prophylaxis Implement environmental controls
Enhance epidemiologic surveillance Ensure provision of health services
Inform professionals about health issues and Enforce laws and regulations relating to health
emerging diseases and disease
Implement and enforce isolation and
Provide emergency risk communication
quarantines
Assist with community evacuation and Manage incidents related to public health
sheltering operations issues/epidemics
Collect health data and report to community, Develop new policies and plans to aid in
responders, and providers preparedness for next disaster
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BDLS® v.3.2
Epidemiologic Surveillance
Ongoing assessment of
community health
Identify new health
concerns/issues (look for
patterns, oddities)
Track and document potential
exposures
Laura Rose/CDC
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BDLS® v.3.2
Epidemiologic Investigation
Comprehensive and multidisciplinary
Investigative work
In outbreaks
– Map spread of disease
– Mechanism of spread
– Identify the “index case”
CDC
– Morbidity and mortality
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BDLS® v.3.2
Rapid Needs Assessment
Determine nature and scale of disaster
Extent of population’s immediate needs
Stability of health care infrastructure
Impact on essential human services
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BDLS® v.3.2
Emergency Public Health Powers
Decrease exposure and
spread of contagious disease
Public health interventions:
quarantine and isolation
Individual rights vs. common welfare
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BDLS® v.3.2
Incident Management
Emergency Support Functions
ESF-6: Mass Care, Emergency Assistance, Housing, and
Human Services
– FEMA, American Red Cross, and Public Health
ESF-8: Public Health and Medical Services
– Public Health traditional lead agency of ESF-8
During certain events Public Health takes incident
command leadership roles
– Biological disasters
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BDLS® v.3.2
ESF-6: Mass Care Services
Public Health Supporting Role
Assessing health and medical
needs of populations
Provision of emergency medical
care
Surveillance in sheltering
facilities
Norman Lenburg/FEMA
Immediate needs: Food, water, shelter, and sanitation
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BDLS® v.3.2
ESF-8: Public Health and Medical Services
Role in Sheltering Populations
Disease outbreaks
– GI and respiratory
Injury safety
– Interpersonal violence
At-risk
Andrea Booher/FEMA
– Worsening of chronic and mental illnesses
Crowding + limited resources = high-stress environment
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BDLS® v.3.2
Sheltering Guidelines
General population shelters
Guidelines for sheltering children
and adults with functional support
needs
Functional Needs Support Services
- “FNSS”
Services enabling individuals to
FEMA
maintain independence!
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BDLS® v.3.2
Health in Disasters
Lodging and shelter
Sanitation, hygiene, and
pharmaceutical supplies
Health testing including
pregnancy management
Protection from physical
and sexual assault Andrea Booher/FEMA
Psychological impact
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BDLS® v.3.2
Vulnerable Populations
Disasters disproportionately affect certain populations:
Infants and children
Pregnant women
Elderly
Those with chronic disease
Those with functional and
access needs Chris Ragazzo/FEMA
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BDLS® v.3.2
Children in Disasters
Disasters do not discriminate by age
Communities need plans for the care
of children in disasters
Emergency managers and responders
must be educated in needs of children
Michael Reiger/FEMA
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BDLS® v.3.2
Children in Disasters
Pediatric Vulnerabilities
Unique Characteristics
– Anatomic
– Physiologic
– Developmental
– Behavioral
– Familial
George Armstrong/FEMA
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BDLS® v.3.2
Children in Disasters
Pediatric Care
Communicate as if your own
child
Provide clinical and emotional
support
Remember special drug doses,
equipment
If able, include parents
Andrea Booher/FEMA
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BDLS® v.3.2
Children in Disasters
Other Pediatric Considerations
Sheltering requires planning
– Special food, diapers, sleeping furniture
– Prone to exploitation and violence
Must keep families together
– Reunification is a high priority
– Medical care, decontamination, shelters
Limited pediatric health access
– Specialty care and ICU beds Jocelyn Augustino/FEMA
Monitor pregnant women to ensure health of fetus
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BDLS® v.3.2
People with Chronic Illnesses
80% of adults over 65 have at least one
Disaster planning is focused on acute
issues
Disasters disrupt:
– Pharmacies, dialysis
– Oxygen supplies, electricity
Liz Roll/FEMA
– Medical infrastructure
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BDLS® v.3.2
People with Chronic Illnesses
Exacerbation of illness due to effects
of disaster
Loss of functional and life-sustaining
equipment, medications, medical
records
Jocelyn Augustino/FEMA
Loss of access to usual health care
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BDLS® v.3.2
People with Chronic Illnesses
Considerations
Individuals should prepare:
– Medical alert
– Identification
– Current list of medications
– Allergies
– History
Thinkstock
Where will patients get dialysis, chemotherapy, tube feeds,
ventilators, bariatric beds?
How to evacuate?
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BDLS® v.3.2
People with Functional or Access Needs
Assistance with:
– Maintaining independence
– Communication
– Transportation
– Supervision Robert Kaufmann/FEMA
– Medical care
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BDLS® v.3.2
Mental Health Effects
Everyone involved will have own response to event
Loss of Difficulty
Fear
appetite Anger concentrating
Worry Confusion
Helplessness
Fatigue
Sleepiness
Reaction of Children = Own Response + Parents’ Reaction
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BDLS® v.3.2
Stress and Psychological Trauma
Psychological Consequences of Disasters
and Other Mass Trauma Events
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BDLS® v.3.2
Responder Mental Health Effects
Susceptible to same psychological
traumas
Should be monitored closely by
team and trained mental health
providers
Realistic training and education
can help
Andrea Booher/FEMA
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Question 1
Large-scale disaster and public health emergencies require
health professionals to shift their perspective from individual
provider relationships to ________ health.
a. Global
b. Population
c. Workforce
d. Personal
e. All of the above
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Question 2
Which of the following is a function of
public health during a disaster?
a. Implement isolation and quarantine
b. Conduct mass vaccination and prophylaxis
c. Promote health and hygiene in shelter operations
d. Provide emergency risk communication
e. All of the above
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Question 3
Disasters disproportionately affect certain vulnerable
populations, including all of the following except _______?
a. Infants and children
b. Elderly
c. Truck Drivers
d. Pregnant Women
e. Those with chronic illnesses
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Lesson Summary
Disasters require us to change our focus from needs of
individual to those of population as a whole
Integration of public health and emergency care is essential
to response and recovery
Certain groups in our communities are especially vulnerable
to the effects of disasters and require special planning
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
Questions?
© 2015 National Disaster Life Support Foundation, Inc. All rights reserved.
BDLS® v.3.2
