Category Archives: Disaster Preparedness

COVID-19: Were we Preapred?

Author: Ron Hilliard, MSN, RN

My name is Ron Hilliard, MSN, RN and I have dedicated much of my career to disaster preparedness and nurses being ready to respond. The COVID-19 pandemic put a whole different perspective on being ready for a major event. I am driven to understand the implications of the COVID-19 pandemic that occurred early this year and I would like to invite a discussion with nurses from the field to understand what they experienced and how we can work together to strengthen our response.

In 2001, I was detailed to establish and manage the HRSA Hospital Preparedness Program to respond to Bioterrorism in Texas under the Texas Department of State Health Services. For over 5 years there was a great deal of federal funding pushed into state public health to prepare for bioterrorism. This included training and equipping health care and public health to be ready if something happened. Great strides were made in expanding public health capabilities and health care, specifically hospitals, being able to handle surge if a biological outbreak occurred. This took a lot of time and effort by many to get to a point we felt like we were ready. Yet, it seems we have had to start all over to prepare for a large-scale disease outbreak while the COVID-19 pandemic is evolving. 

That raises a lot of questions. How did it have a direct effect on nurses? Please share what you have experienced from the aspect of being prepared for this event.

  • What did you, as a nurse, experience in being personally ready for the COVID-19 outbreak and your response to the pandemic?
  • What advice can you give to other nurses, especially those new nurses that are struggling with entering the profession and facing a major disease outbreak at the same time?

It was 20 years ago that states started preparedness efforts for such events. Over the years, we had no major events that pushed us to fall back on those preparations and the readiness posture fell off the radar with the effort to sustain those preparations not staying as a priority. The result was we were not ready for a large-scale event. We first saw the gap in preparation for a biological event with the Ebola incident in Dallas that occurred in 2017. A large number of personnel that led these initial efforts have all pretty much retired and the historical experience has been lost.

I hope we can take this opportunity to learn from each other and promote activities that will make us stronger.

What Nurses Need to Know about the Coronavirus (2019-nCoV)

We have all been hearing about the coronavirus that originated in Wuhan, China for a few weeks and like most Americans were probably not too worried until it was shown to be able to spread by person to person contact. As of today, there are 5 known cases in the United States with over 2700 cases and 81 deaths in China alone. Since December the virus has spread to France, Japan, Malaysia, Nepal, Singapore, South Korea, Taiwan, Thailand, United States, and Vietnam.

How it Spreads

It is not fully known how coronaviruses are spread or if there will be a sustained person to person spread. Currently, China is reporting sustained person to person spread. In the U.S. there are no reports of sustained person to person spread, but if it does occur then it would be possible to see such cases in hospitals and clinics.

How easily a disease spread is of equal importance. For example, measles is highly contagious and spreads easily. CDC list the immediate risk for the coronavirus as low.


Symptoms may appear between 2 and 14 days after exposure. The most common symptoms are:

  • Fever
  • Cough
  • Shortness of breath

Prevention and Treatment

The prevention recommendations at this time are the same as they would be for the flu or other respiratory illness.

  1. Wash your hands often.
  2. Don’t touch your eyes, nose, or mouth if you haven’t washed your hands.
  3. Avoid close contact with sick people
  4. Stay home if you are sick.
  5. Cover your cough.
  6. Clean surfaces and things you touch often.

Treatment is supportive. There is no specific antiviral treatment at this time.

For More Information

Research Request from Disaster Nursing Researchers


We are nurse researchers who are interested in exploring the experiences of nurses who have volunteered for more than one disaster relief effort. Much of the research highlights the negative personal effects resulting from disaster relief volunteerism. We are conducting a small qualitative study in the hopes of having a better understanding of the reasons why so many nurses continue to volunteer after their initial disaster relief deployment.

If you are a registered nurse and have participated in more than one disaster relief effort, we invite you to participate!

Data collection will be through phone interviews, which will take approximately 30 minutes. No names will be used in the reporting of the data and the information you provide will be kept strictly confidential.

Please email or call if you are interested in participating. We are happy to answer any additional questions you may have!

Thank you,

Stacy Christensen DNP, APRN 860-463-2964

Linda Wagner EdD, RN 860-965-7665

Melissa Masse APRN 860-748-0070


Zika and Flint Water Public Health Emergencies: Disaster Training Tool Kits Relevant to Pregnant Women and Children

 2019 Jun 20. doi: 10.1097/JPN.0000000000000418. [Epub ahead of print]

Pregnant women and children and individuals suffering from chronic illness are disproportionally impacted by public health emergencies. To meet the healthcare needs of these populations, the nursing workforce must be capable of responding in a timely and appropriate manner. The goal of this project was to create interactive and engaging evidence-based educational tool kits to advance healthcare provider readiness in the management of population health in response to the Zika and Flint Water crises. A multipronged, mixed-methods approach was used to identify essential education needs and required core competencies. Data were synthesized from discussion with key informants, review of relevant documents, and surveys of schools of nursing, public health, and medicine. The ADDIE model was used to integrate results into the development of the online learning tool kits using the ThingLink software program. An innovative online educational program to prepare healthcare providers to rapidly identify, mitigate, and manage the impact of the Zika and Flint Water crises upon pregnant women and children was implemented by the Society for the Advancement of Disaster Nursing. Innovative online learning tool kits can advance healthcare provider readiness by increasing knowledge and understanding of key components of specific public health emergencies.

PMID: 31233449


DOI:  10.1097/JPN.0000000000000418

Disaster Nursing: From Theory to Practice

By: Cole Edmonson DNP, RN, FACHE, NEA-BC, FAAN

It’s been just over two and a half years that the SADN Practice workgroup has been meeting monthly under the guidance of the SADN organizational structure.  The Practice workgroup has included a consistent and engaged team of a dozen nurse colleagues, who have dedicated not only their time but their talents as well. Many of the members have experience responding to major disasters, teaching disaster education and are compelled to communicate their experience in ways that strengthen and support our national nursing workforce in preparedness, response, and prevention to various disasters.

As described by a collective group of disaster nursing experts (Veenema 2016), the focus of the Practice workgroup is to achieve actionable steps towards the following recommendations:

Practice 1.1 Health care and related organizations support clinical nursing practice during disasters to reflect crisis standards of care and address common barriers to the willingness of nurses to respond to a disaster.

Practice 1.2 Establish a collective effort among nurse leaders to advance the practice of disaster nursing and public health emergency preparedness and response.

Practice members have delivered 7 presentations during the past two years for the national, county and local audiences on a range of topics that include; a disaster nursing call-to-action, personal preparedness, psychological resilience and the role of information technology in disaster preparedness. Six of our members were invited by the Emergency Nurses Association (ENA) to provide the evaluation for a mass casualty disaster drill during the 2017 ENA annual convention in St Louis, MO. We are currently working with the Girl Scouts to develop a disaster preparedness badge that could be integrated into the activities of the Girl Scout STEM camps and disseminated nationally. The promotion of personal preparedness serves as the cornerstone of most of our activities and we have identified the following website to use as a resource:

This past year we welcomed five new members: Including the transition of the chair position.

Cole Edmonson, D.N.P., R.N., FACHE, NEA-BC ( Chair ), June 2018

Chief Clinical Officer, AMN Healthcare

Kimberly K. Hatchel, DNP, MHA, RN, CENP, August 2018

Market CNO/Senior VP, Lexington One Health

Melinda Hirshouer, DNP, RN, MBA, MHSM, June 2018

Director of Inpatient Rehabilitation at Texas Health Presbyterian Hospital Dallas

Laurie G. Combe, MN, RN, NCSN

President-Elect, National Association of School Nurses

Nicole “Nikki” M. Ward, Maj, USAF, NC

HAF Junior Nurse Executive Fellow

Office of the Surgeon General

Medical Force Development (SG1/8AN)

We are honored to be part of the larger SADN group.  The work and success of each workgroup excite and motivates us to accomplish more.  We are all driven by a common purpose to assure nurses are prepared to competently and safely respond and lead in disaster scenarios.


Kimberly Hatchel

The experience of Kimberly Hatchel, Chief Nursing Officer

My name is Kimberly Hatchel and I was the Chief Nursing Officer at Sunrise Hospital and Medical Center – a Level II Trauma Center when the October 1st, 2017 Mass Casualty Incident – Active Shooter event occurred in Las Vegas. The event officially announced a little after 10pm, produced 24 hours full of actions aimed at saving human life.

At approximately 2225 the first private vehicle arrived at Sunrise carrying patients. This notation is significant as the number of patients shot in this event thrust those not injured into the immediate role of the first responder. Arrival patterns of patients were also uncertain as there was no ability to announce their arrival. At 2229 the first ambulance arrived carrying patients.  At 2300 the first patient was triaged to the ICU and by 2330 a code triage was called as the magnitude of the event was both being felt and understood. By 2359 five surgeries had been completed.

By 0112 over 100 physicians had responded and by 0200 over 200 nurses had responded. This number proved to be significant as the severity of patient injury required 1:1 nursing care of patients in the initial stabilization and transfer to surgery or ICU. By 0247 the Emergency Department had 228 patients in various stages of treatment in a 52-bed Emergency Department. By 0451 we had 167 patients discharged/transferred from the hospital. By 0545 the Clark County Corner arrived to clear the release of the non-surviving victims of the mass casualty shooting. By 1100 Emergency Department Operations had returned to normal. By midnight on 10/2 – 56 surgeries had been completed. There were 212 known victims treated and an additional 30 who elected not to remain and allow the more severely injured patients to be treated in the first few hours after the event.

The Level I trauma center had been put on diversion. This was the catalyst for the Level II to take twice as many patients.


Research Request from Nizar Said

Information for member nurses

RE: Psychological preparedness for disasters among nurses with disaster field experience (an Online Survey)

Dear Colleagues,

You are cordially invited to participate in a disaster preparedness study conducted by a PhD candidate, Mr. Nizar SAID, who is supervised by Associate Professor Dr Vico Chiang, and co-supervised by Professor Alex Molasiotis of the School of Nursing in The Hong Kong Polytechnic University.  The project has been approved by the Human Subjects Ethics Sub-committee (HSESC) of The Hong Kong Polytechnic University (HSESC Reference Number: HSEARS20190118001).

The disaster preparedness study has the purpose to investigate the outcomes of a psychological first aid (PFA) training programme, with the aim of this phase I as an online survey to 1) investigate psychological preparedness for disasters among nurses with disaster field experience, and 2) evaluate the extent of psychological preparedness of nurses with disaster filed experience in relation to self-efficacy, dispositional optimism, trait anxiety, and self-esteem.

The results obtained from this survey will be useful to inform the better structure of the PFA training for further study in the next phase. This study will involve completing a questionnaire, which will take you about twenty minutes to complete. The questionnaires contain five sections.

The study should not result in any undue discomfort. All information related to you will remain confidential and will be identifiable by codes only known to the researchers.

As a participant, you should have participation in at least one disaster relief work on-site or in the related clinical setting (e.g. hospital).

We would be very grateful if you may also further spread the online survey link for other nurses whom you know and have disaster filed experience to join the study.

In order to appreciate your participation in this survey, three free registrations for the upcoming Asia Pacific Emergency and Disaster Nursing Network (APEDNN ) conference in September 2019 at Hong Kong will be offered. If you would like to join this lucky draw, please provide your email address at the end of this survey.

The survey link:

Sincerely Yours,

Mr. Nizar Said


The NHDP-BC exam, a certification for disaster professionals

By Bonnie McIntosh, BSN, RN, CEN, NHDP-BC

The ANCC just made available a new certification for disaster professionals. It is called National Healthcare Disaster Professional by Certification or NHDP-BC. The cost when I took it was $290.  I noticed that the price stayed the same even though the ANCC website said the cost would go up by $100 starting in 2018.

To qualify to take the test you have to be one of ten healthcare professions with 3 years of disaster experience in the last 10 years. The other requirements include certificates from completing FEMA web-based classes (IS 100.b, 200.b, 700.a, 800.b), and participated in a MCI exercise.

Just like any other certification exam, it is at a testing center.  The test has 175 questions – 150 are scored and you need 70% to pass. The ANCC does not give you a score but I called and the test is worth ‘500’ and passing is ‘350’. It is a long test time – you have up to 3.5 hours to complete it. I was able to complete the test in 2 hours and not rush.

To prepare for the test I used a web-based company called Exam Edge which was the only one I could find with practice questions. Comparing the actual test with Exam Edge, I found the ANCC test was a lot less wordy and had more questions related to HAZMAT levels, PPE levels, triage of victim scenarios, etc. For anyone liking alphabet soup, a whole lot of acronyms are used.

When you pass the exam, you will receive a certificate to frame for your office, a card to carry in your wallet, and a cool coin. I would recommend the certifications to anyone in disaster management.

Secondary Trauma: No Bruises Left Behind

By Elizabeth Fiegel DNP, MSN, RN NEA-BC

I know that when I inventoried nine full oxygen tanks just this morning they were all there in the rack.  I have looked everywhere and for the life of me, I cannot determine where three of the nine might have gone.  If there is not at least a full rack, we will simply not have enough to last throughout the night. These patients desperately need oxygen to survive.  Then I checked everywhere, and our supply of saline has also run critically short; we certainly had at least a full case just this morning, and will not be getting another delivery until after the hurricane has passed, maybe for many days.  We have an emergency room full of patients who might need this saline for their critical injuries.  What am I going to do?  I must report back to the incident command center and I am confident that the supplies were correctly inventoried, and ready for the storm just this morning.  Surely, I will be held to blame, I feel my heart racing, my mouth is dry and the sweat droplets are forming on my brow, the room is spinning. Oh no, I must sit down for just a moment; I am not sure… I just can’t hold back the tears and can’t do this anymore.  As I hold my face in my hands, in this very dark room, my pillow now stained with my tears, I suddenly realize that my husband is gently rousing me from my deep sleep and this terrible nightmare. Then, I recall that I was just reliving the hurricane preparations at my local hospital, where I had worked for seven twelve hour shifts in a row after volunteering at the emergency shelter.  It has been over two months since the hurricane, and I still cannot sleep through an entire night, and have had trouble focusing at work.  My husband is worried about me and I just don’t seem to find joy in anything right now.Fiegel photo-3.jpgFiegel-photo-2.jpg

This story is an example of secondary trauma suffered by a nurse who volunteered during a major hurricane.  She had been a nurse for over 35 years during some of the worst hurricanes ever to hit the gulf coast.  She was a seasoned nurse with a clinical background in emergency and trauma care.  She had seen some of the worst types of injuries and nothing seemed to faze her; she could tolerate blood and traumatic injuries with the best of them. Clinicians, however, are not immune to Secondary Trauma, which is defined as trauma-related stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, or the event itself (SAMHSA, 2014).  Secondary Traumatization is also referred to as compassion fatigue (Figley, 1995) and vicarious traumatization (Pearlman and Saakvitne, 1995).

As Hurricane Florence struck a heavy blow to the east coast this last month resulting in devastation and loss of life, I am reminded that healthcare workers respond to disasters often in a moment’s notice in the dark of night and leave their family and personal needs behind to care for others.  They put in long hours without sleep and work under grueling conditions, even neglecting their own health and safety at times.  The combination and interaction of systemic and traumatic stresses place nurses and others working in the health care field at an increased risk of suffering from serious negative stress effects in the areas of physical, emotional, cognitive, behavioral and interpersonal well-being (Rosh, 1996).  There are no bruises or scars in Secondary Trauma; the signs of Secondary Trauma are often missed in healthcare providers but demonstrate themselves as:

  • Fatigue
  • Sleep disturbances
  • Changes in appetite
  • Chronic muscle tension
  • Sexual dysfunction
  • Irritability
  • Fear of impending doom
  • Isolation
  • Replaying events in one’s mind over & over
  • Difficulty making decisions or problem-solving

According to The International Society of Traumatic Stress Studies (2018), there are effective strategies for preventing and reducing the effects of stress reactions, and preventing secondary traumatic stress in healthcare providers:

  • Eat nutritiously and regularly every day
  • Get adequate sleep each night at least 6-8 hours
  • Exercise regularly for at least 30-60 minutes each day
  • Be aware of your stress level; take precautions against exceeding your own limits, by practicing mindfulness, yoga or meditation
  • Acknowledge your reactions to stressful circumstances; allow yourself time to cope with these emotions, seek personal or group therapy
  • Take scheduled vacation or days off in between work shifts

Some organizations attempt to reduce the incidence of secondary trauma in healthcare workers by offering formalized post-event debriefings. Structured events allow for a review of readiness to response and evaluation of reactions to the events themselves.   Practice guidelines on debriefing formulated by the International Society for Traumatic Stress Studies (2018) conclude there is little evidence that debriefing prevents the effects of secondary trauma. The guidelines do recognize that debriefing is often well received and that it may help (1) facilitate the screening of those at risk, (2) disseminate education and referral information, and (3) improve organizational morale. However, the practice guidelines specify that if debriefing is employed, it should be conducted by experienced, well-trained practitioners, not be mandatory, utilize some clinical assessment of potential participants, and be accompanied by clear and objective evaluation procedures.   Currently, many mental-health workers consider some form of stress debriefing the standard of care following both natural (earthquakes) and human-caused (workplace shootings, bombings) stressful events  For individuals who demonstrate serious signs and symptoms of Post-Traumatic Stress Disorder, and/or harm to themselves or others, individual therapy and immediate crisis intervention may be needed (Dept. of Veterans Affairs, 2018).

Disaster response is often a well-coordinated event by healthcare workers and first responders, rending lifesaving aid to millions of others, providing hope to the hopeless, and compassion to the heartbroken; truly, this has been evident during and after Hurricane Florence, Katrina, and many other natural disasters. Understanding the etiology of Secondary Trauma, early recognition of signs and symptoms and strategies to avoid the negative impact of Secondary Trauma can result in healing for both the healthcare worker and those they aide.  While valuables, personal treasures, and homes can be lost, lives can be restored and healthcare workers and first responders play a unique and important role in recovery; providing for their health and wellness is essential in disaster management.





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