Disaster Preparedness and the Difference Health Care Providers Can Make

by: Charleen C. McNeill, PhD, MSN, RN

The United States (US) approach to managing risks associated with disasters has historically relied on governmental intervention (FEMA, 2011).  However, population shifts, the growing number of people living with chronic conditions and/or disabilities, and the growing number of older citizens living independently have forced a change in the focus of disaster preparedness efforts. To improve the nation’s resilience, the US government has shifted more preparedness responsibilities on to individual citizens (FEMA, 2011).  Because of this shift, significant access and service gaps exist.

Despite the launching of the Citizen Preparedness Campaign in 2003, the levels of emergency preparedness in the US have not increased (Citizen Corps, 2009; Al-rousan, Rubenstein, & Wallace, 2014; McNeill et al., in press).  Disaster preparedness levels among individuals in our society are even more in the forefront after the 2017 hurricane season and the devastation left after Hurricanes Harvey, Irma, and Maria.  During the months of August and September of 2017, Hurricane Harvey and Irma caused the death of over 200 people; thousands were left without water, food, shelter, and medical care (Moravec, 2017; Phys.org, 2017; Texas Hospital Association, n.d.). On September 20, 2017, Hurricane Maria hit Puerto Rico leaving in its wake an official death count of 64 (Kishore et al., 2018).  However, an increase in subsequent fatalities as compared to historical patterns of death in Puerto Rico suggest the death toll may be greater than 70 times the official estimates (Kishore et al., 2018).  The devastation caused by Hurricane Maria is still acutely impacting its residents to this day.

We must consider our part in the disaster management cycle and the interventions we can undertake to improve patient outcomes during the direst of times.  To prepare members of our society for emergent events, improve access, and decrease service gaps, we must consider how we, as nurses and health care providers, can educate our clients and assist them in becoming more prepared.  Recent research highlights the strong, positive relationship between health-care provider education of patients with chronic conditions regarding emergency preparedness and that patient’s emergency preparedness level, indicating a pathway for effecting change in preparedness levels among such vulnerable populations (Al-rousan, Rubenstein, & Wallace, 2014; McNeill et al., in press).  According to these studies, patients with chronic conditions who received emergency preparedness education from their health care provider were three to four times more likely to be prepared for emergencies.  It is imperative that we arm ourselves with the knowledge to educate our patients on how they can be prepared, inclusive of their medical needs, to facilitate better health outcomes after disasters.  I urge each of us to do just that.  The 2018 hurricane season is upon us.  Let us all take action and routinely include disaster preparedness education for our patients and clients starting today.


Al-rousan, T., Rubenstein, L., & Wallace, R. (2014). Preparedness for natural disasters among older US adults: A nationwide survey. American Journal of Public Health. 104(3). doi: 10.2105/AJPH.2013.301559

Citizens Corps. (2009). Personal preparedness in America: findings from the 2009 Citizen Corps national survey. Retrieved from http://www.citizencorp.gove/ready/researchshtm.

Federal Emergency Management Agency (FEMA). (2011). A whole community approach to emergency management: Principles, themes, and pathways for action [FDOC 104-008-1].  Retrieved from http://www.fema.gov/library/viewRecord.do?id=4941

Kishore, N., Marques, D., Mahmud, A., Kiang, M., Rodriguez, I., Fuller, A., … Buckee, C. (2018). Mortality in Puerto Rico after hurricane Maria. New England Journal of Medicine. doi: 10.1056/NEJMsa1803972. Retrieved from https://www.nejm.org/doi/pdf/10.1056/NEJMsa1803972

McNeill, C., Killian, T., Moon, Z., Way, K., & Garrison, M.E. (in press). The Relationship Between Perceptions of Emergency Preparedness, Disaster Experience, Health-Care Provider Education, and Emergency Preparedness Levels. International Quarterly of Community Health Education. doi: 10.1177/0272684X18781792

Moravec, E. R. (2017) Texas officials: Hurricane Harvey death toll at 82, ‘mass casualties have absolutely not happened.’ Retrieved from https://www.washingtonpost.com/national/texas-officials-hurricane-harvey-death-toll-at-82-mass-casualties-have-absolutely-not-happened/2017/09/14/bff3ffea-9975-11e7-87fc-c3f7ee4035c9_story.html

Phys.org. (2017, September 27). Hurricane Irma death toll rises to 72 in Florida. Retrieved from https://phys.org/news/2017-09-hurricane-irma-death-toll-florida.html

Texas Hospital Association. (n.d.). Special report: Texas Hospital Association Hurricane Harvey analysis: Texas hospitals’ preparation strategies and priorities for future disaster response. Retrieved from https://www.spartnerships.com/wp-content/uploads/Harvey_Special_Report_FINAL_web.pdf

Charleen McNeill is an Assistant Professor at East Carolina University, College of Nursing

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