Author Archives: Roberta Lavin

Crisis Standards of Care: Are You Familiar?

by: Denise M. Danna, RN, DNS, NEA, BC, CNE. FACHE

Due to such disasters as Hurricane Katrina, the tornado in Joplin, and various other
catastrophic events across the country and globe, the Department of Health and Human Services (HHS) requested that the Institute of Medicine (IOM) create a committee to develop standards of care during disasters. As citizens, we frequently experience how our health care system and the infrastructure of a community can be overwhelmed in such catastrophic disasters.

Several reports were generated from the IOM committee on Crisis Standards of Care (CSC). The first report in 2009, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations developed a definition of crisis standards of care “as a substantial change in usual health care operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g. pandemic influenza) or catastrophic (e.g. earthquake, hurricane) disaster. This change in the level of care delivered is justified by specific circumstances and is formally declared by a state government, in recognition that crisis operations will be in effect for a sustained period. The formal declaration that crisis standards of care are in operation enables specific legal/regulatory powers and protections for healthcare providers in the necessary tasks of allocating and using scarce medical resources and implementing alternate care facility operations” (IOM, 2009). The second report entitled, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response (IOM, 2012) developed CSC templates to assist and guide individuals and organizations in CSC planning and implementation (IOM, 2012). Some of the main reasons that CSC protocols are needed in catastrophic disasters are to ensure that critical resources are provided to those individuals who will benefit the most, conserve limited resources, and ensure that all individuals receive the same access to the best possible care.

Nurses play a vital part in participating in the development of CSC. I was asked to participate in an interdisciplinary task force charged with developing crisis standards of care protocol. My section was writing “Delivery of Care Guidelines for Essential Inpatient Nursing Care” (Louisiana Department of Health & Hospitals, 2011). In developing the essential inpatient nursing care guidelines, the ANA report, Adapting Standards of Care Under Extreme Conditions: Guidance for Professionals During Disasters, Pandemics, and Other Extreme Emergencies (2008) was referenced. This report identified critical standards for healthcare providers that should always be maintained during a disaster (e.g. worker and patient safety, maintaining airway and breathing, circulation, control blood loss, and infection control (ANA, p. 16). Standards of care that could be adapted under extreme conditions included such activities as routine care (e.g. vital signs for non-acute patients), extensive documentation of care, and elective procedures (ANA, p. 16).

It is recommended that each hospital develop its own recommendations for providing essential nursing care during a catastrophic disaster that mirrors the community’s in which they live (Murray, 2012). Nurses serve an important role in disasters. Nurses should familiarize themselves with CSC and work within their organizations and communities to develop and implement CSC. During times of disasters, scarce resources may occur and nurses need to know how standards of care may be adapted while still providing safe, ethical and quality nursing care (Murray, 2012).


ANA (2008). Adapting Standards of Care Under Extreme Conditions: Guidance for
Professionals During Disasters, Pandemics, and Other Extreme Emergencies. Retrieved

Institute of Medicine (2009). Report Brief. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. Retrieved from:

Institute of Medicine (2012). Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Retrieved from:

Louisiana Department of Health & Hospitals. ESF-8 Health & Medical Section. State Hospital Crisis Standard of Care Guidelines in Disasters (Version 1.2 September 2011).Retrieved from:

Murray, J. (2012). Crisis Standards of Care: A framework for responding to catastrophic disasters. AJN, 112 (10), 61-63.

Are Mass Shootings A Disaster

by Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAAN

Mass Shooting Events (MSE) are a public health crisis in America. “We are on track in this country to have more mass shootings this year than in 2017 (, 2018). That is clearly unacceptable. Although, it’s not about the numbers, it’s about people, and people are not statistics. The numbers speak to the ever-increasing plague of gun violence on individuals, families, communities, and our country. Thirty-four mass shootings ( in the first month-and-a-half alone of 2018”. Lack of effective gun control measures, mental health resources in this country along with extreme political views, extreme religious views, racism, hate are a deadly combination. Of course, these are not the only factors in the epidemic we are facing. If we can get upstream in this epidemic, perhaps we will need less reactive measures or even be able to prevent mass shootings.

2017 Gun Violence Statistics 

  • 61,507 Active Shooter Incidents
  • 15,592 Deaths
  • 3,996   Children / Teens killed or injured
  • 19 days in the year without a mass shooting.

Mass shootings represent a clear disaster event for public servants, the health care system and the nursing profession among many others. “Schnur makes several recommendations as a nurse researcher in her article ‘Is there a cure for gun violence’ for the nursing profession ultimately assisting in the prevention of mass shooting.

  1. Increase access to mental health programs for individuals, families, and students from elementary school through college:
  2. Include a gun safety assessment as part of routine health screenings for all patients:4
  3. Several states continue to propose legislation to ban practitioners from documenting gun ownership in the patient’s record.
  4. Develop and implement Evidence-based Hospital Violence Intervention Programs focusing on:
  5. Improve Community engagement/outreach and education programs with initiatives targeting:
  6. Gather more data, conduct research and educate families on how to best protect themselves and their families from gun injuries”

“We can’t solve a wicked problem with naïve eclecticism. An epidemic of this proportion will take all sectors, public, private, non-profit and governmental, working together to solve this crisis. We, as nurses, some 3.9 million strong in the U.S., can be a powerful voice. Those with greater expertise will propose possible solutions including universal background checks, raising age limits, making bump stocks illegal, restricting certain types of guns from the general population, mandatory waiting periods, database reporting and many more.” We have the knowledge and wisdom to work from local, state, and national levels, from grassroots advocacy to legislative action. Prevention and mitigation should be our first priority along with preparedness, readiness, response, and recovery.

I can continue to applaud the bravery of those advocating for change, especially our youth – as small passionate groups of people can make a change, that can grow into a tsunami of moral virtue to do what is right!


Edmonson, Cole (2018) TONE Newsletter. Retrieved from

Gun Violence Archive (2018). Retrieved from

Kodjak, A. (2018).What if we treated gun violence like a public health crisis. Retrieved from

Schnur, M. (2016). Retrieved from

Hurricane Season—Are You Ready?

by: Lavonne Adams, PhD, RN, CCRN

How ready are you for a hurricane? Even if you don’t live along the coast, you are not immune to hurricane effects, since remnants of major storms can produce widespread damage from heavy rain, flooding, and tornadoes. Such conditions pose risks to health and safety, so prior preparation is crucial. As I write this entry, we are well into hurricane season, which runs June 1st to November 30th for the Atlantic, and May 15th to November 30th for the Pacific. If you haven’t already done so, consult for many helpful recommendations and links so you can prepare your family, home, and vehicle before a storm and learn how to act in the event of a storm.

Highlights include:

  • Know if you live in an evacuation area.
  • Become familiar with National Weather System watches and warnings
  • Have a weather radio
  • Establish a communication plan in case your family isn’t together when hazardous weather strikes
  • Develop an emergency plan that includes your pets and includes locations away from home
  • Keep an emergency kit—including food and water—on hand in the event power goes out or roads are impassable
  • Check on elderly or disabled family and neighbors
  • Get your home ready for a storm. Be aware of what to do in case of power outages. Make sure you consider:
    • Clearing the yard of anything that could blow around and damage your home
    • Covering windows and doors
    • How to turn off your power
    • Filling clean containers with drinking water; filling bathtub and sinks for washing
    • Emergency charging options for devices like cell phones
    • Alternatives if home medical equipment uses electricity
  • Ensure your vehicle is travel-ready and has a full tank of gas
  • Keep an emergency kit in your car
  • Consider whether you need to shelter in place or evacuate
  • Be ready to leave; if you need to evacuate, follow instructions by local officials
  • Be careful while evacuating; watch for:
    • Flying debris
    • Broken objects
    • Downed power lines
    • Flooded roads
    • Tornadoes
  • Wait until the area is declared safe before you return home

The American Red Cross also has a useful Checklist for hurricane preparedness.

Lavonne Adams is an Associate Professor at TCU Harris College of  Nursing and Health Sciences

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;, 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

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

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 (2017, September 27). Hurricane Irma death toll rises to 72 in Florida. Retrieved from

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

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

Development of a Tiered Assessment Tool for Disaster Nursing Competencies

Researchers with the Idaho State University School of Nursing and the Idaho Public Health Association are interested in developing a disaster nursing competency assessment tool for use with baccalaureate nursing students. We are requesting your assistance with developing a tied competency assessment tool based on the International Council of Nurses and World Health Organization (2009) Framework of Disaster Nursing Competencies. The online survey is anonymous and takes approximately 10 minutes to complete.

Please complete the survey by Friday, February 16, 2018, and please forward this email to nurse colleagues who work in disaster health or teach disaster health nursing.

After pilot testing the instrument we will provide survey participant the survey results and a copy of the assessment tool if requested. For more information please contact Dr. Mark Siemon, PhD, RN, PHNA-BC, CPH at

Thank you for your help with this request.

Mark Siemon

Idaho Public Health Association

Now is the Time, Personal Preparedness Can’t Wait!

On August 25, 2017, Hurricane Harvey made landfall in Texas leading to catastrophic flooding in Houston and surrounding areas.  Less than two weeks later, Hurricane Irma slammed into the Caribbean and Florida, causing flooding, damage, and widespread power outages.  Most hospitals in the impacted areas sheltered-in-place requiring nurses and other critical staff to stay at the facilities for extended periods.

While these disasters had some advance warning, many aspects of the disaster were uncertain including the extent and location of flooding, power outages, etc. Other disasters, such as tornadoes or earthquakes, strike with little or no warning. Previous studies have found that lack of personal preparedness, concern/fear for family and pets, concern for the effect of the disaster on self and personal property, and transportation difficulties pose major barriers to disaster response. Although many agree that healthcare organizations should address the personal preparedness of their employees, little is known about the degree to which the U.S. nursing workforce is personally prepared to respond to disasters for extended periods of time.

The Society for the Advancement of Disaster Nursing believes personal preparedness of the nursing workforce is paramount. This week, SADN members will be hosting a presentation on personal preparedness at the Emergency Nurses 2017 Conference in St. Louis, MO (Details below).

Title: Now is the Time, Personal Preparedness Can’t Wait!
Date: Thursday, September 14, 2017
Presentation time 3:15 PM – 4:15 PM
Room: 267

We hope conference attendees will be able to join us for this session.

For nurses who are not attending this conference, we recommend you undertake the following steps to get prepared as soon as possible:

  1. Assemble disaster supplies kit for home, work, and car
  2. Create a family disaster plan. Your family may not be together if a disaster strikes, so it is important to know which types of disasters could affect your area and have a plan in place that addresses how you’ll contact one another and reconnect if separated. Tailor this plan to any special needs your family has, including care of pets.
  3. Practice and update your plan regularly, just like a fire drill.
  4. Familiarize yourself with your organization’s emergency operations plan and know your role if a disaster strikes.

See for more information on becoming personally prepared.

Alicia Gable, MPH

Academic-Practice Partnerships Can Improve Preparedness

The United States needs a healthcare and public health workforce that possesses the knowledge, skills, and abilities to respond to any disaster or public health emergency in a timely and appropriate manner. The level of readiness and willingness to participate is critical to the success of any large-scale disaster response. The role of healthcare professionals across a broad range of specialties and during all phases of a disaster should be understood as disaster competence will be critical to population outcomes. The absence of a clearly articulated vision and framework for disaster education is not without consequences. An unprepared workforce has the potential to limit the effectiveness of local, state and federal response plans, limit organization surge capacity and to negatively impact health outcomes in populations impacted by disasters.

A team of researchers from the University of Missouri – Saint Louis, Saint Louis University, and Johns Hopkins recently undertook a multi-pronged approached to identify essential educational needs and core competencies, as well as to assess the status of integration of state and local-level population focused training. Data were synthesized from in-depth discussions with key informants, review of relevant documents, guided discussions at key partner stakeholder meetings, review and abstraction from available core competencies and other government planning documents, the survey of medical, public health, and nursing programs and interviews with experts.

We developed a toolkit using a collaborative and partner-centered approach to disaster preparedness and response which is designed for interdisciplinary workforce development. We are posting all of the toolkits on and are dedicated to making them all available in the Creative Commons. The modules, curriculum, and workshop all reflect collaboration between public health and primary care. The flexible guidance will help primary care providers to apply theoretical principals during disaster response and preparedness activities with a population focus. A workforce that is continually learning and collaborative is essential to prepared communities. All are welcome to attend the workshop that is scheduled for July 27, 2017. You can register at . The event is free, but registration is required.



Society for the Advancement of Disaster Nursing (SADN) Leadership Conference


DAY 1 Wednesday December 14th 2016

6:00-8:30pm Panel discussion on the CTA Project

Carpenter Room 6-9pm, Reception, JHSON Alumni Development Office.

DAY 2 Thursday December 15th 2016 

Morning Closed Session, By Invitation only

8:00-8:30am Continental Breakfast at JHSON

8:30-10:15am Society for the Advancement of Disaster Nursing (SADN) Leadership Working Meeting

  • Welcome and Meeting Overview
  • Acknowledgement of VEMEC
  • Introductions
  • Business Meeting Call to Order
  • Respond to Draft Strategic Plan
  • Brief
    presentations from national subcommittees
  • Discussion: Conduct the preliminary business of launching the new organization

10:15-10:30am Break

10:30-10:45am Welcome Remarks, Dean and Professor Patricia Davidson

10:45-12:00pm Small workgroups

12:00-1:00pm Conference Keynote Presentation

Sally Phillips, R.N, PhDMain Content

Deputy Assistant Secretary for Policy
Office of the Assistant Secretary for Preparedness and Response
U.S. Department of Health and Human Services

Afternoon Closed Session, By Invitation only

1:15 Boxed lunches served -Carpenter Room

1:30-2:00pm Future Directions, Presentation, Closing Remarks

  • Disaster Nursing and Humanitarian Health, Paul Spiegel

2:00-2:45pm Present strategic plan; get feedback from attendees

  • Discuss regarding optimizing partnerships

2:45-3:00pm Closing remarks



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