Competencies are essential; they serve as a foundation of research, evidence-based practice, and standard development (Lavin et al., 2017; Noh et al., 2017; Veenema et al., 2016). Competencies specific to the healthcare providers’ specialties help further define the responder’s role. Competencies serve as a valuable tool in determining if a healthcare provider has the knowledge, skills, and abilities to function safely during a disaster event.
and the educational needs to respond to a disaster. The ICN developed Version 2.0 and eight domains were identified, which considered collaborative health professional areas and the need for common preparedness approaches among professionals that must work together, which was built upon the ICN Framework of Competencies for the Generalist Nurse (International Council of Nurses, 2019). The eight domains are: preparation and planning, communication, incident management systems, safety and security, assessment, intervention, recovery, law, and ethics.
CRISIS STANDARDS OF CARE
conditions. Crisis standards of care are a framework rooted in fundamental public health tenets. Decisions regarding the delivery of care must be made focused on population, not necessarily individual, outcomes (Technical Resources, Assistance Center, and Information Exchange, 2021). To limit patient and victim morbidity and mortality, coordinating emergency response system planning is essential to ensure successful health and medical outcomes when healthcare systems are stressed to the breaking point, disrupting the delivery of vital medical services. Emergencies that reach the level required of “crisis standards of care” most often are multijurisdictional, statewide, and involve various local, regional, state, and federal authorities. Crisis standards of care are an ethical platform that addresses fairness, the duty to care, the duty of steward resources, transparency, consistency, proportionality, and accountability. Functioning in stressful and ethically challenging situations requires the healthcare provider to adhere to designed crisis standards of care. Disasters are guaranteed to occur. Healthcare providers must be professionally and personally prepared to address disaster events. Healthcare Consideration : The deliberate use of chemical, biological, radiological, and nuclear agents would be a serious threat to the health security of the nation. Anticipation and preparedness to respond effectively to these threats require effective planning, response, and recovery efforts. Crisis standards of care define the level of care possible during a crisis or disaster because of limitations in supplies, staff, environment, or other factors.
When responding to natural and manmade disasters, healthcare workers can find themselves operating in an altered standards- of-care environment. Every profession has established codes of ethics that speak to their duty to those they care for. An example of this is the nurse’s duty to care inferred from Provision 2 of the ANA Code of Ethics for Nurses with Interpretive Statements (2015): “The nurse’s primary commitment is to the patient” (p.9). The ethical obligation to care for others also extends to the care of the nurse as identified within Provision 5 which states, “The nurse owes the same duty to self as to others” (p.18). The conflict of obligation to provide care to critically ill or wounded patients for extended periods of time influences decisions regarding the amount of high-quality care nurses can provide to others while considering their own health during a disaster. The American Nurses Association, as a member of the Institute of Medicine’s (2009) Forum on Medical and Public Health Preparedness for Catastrophic Events, participated in writing the framework Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report, which outlines how protocols can be designed to protect nursing professionals operating in extreme conditions and scarcities while at the same time ensuring that the public receives the most adequate medical assistance as possible. The Office of the Assistant Secretary for Preparedness and Response (ASPR) addressed establishing crisis standards of care following three reports provided by the Institutes of Medicine of the National Academies to provide a reasonable approach to healthcare service delivery under catastrophic disaster The role of the medical community At the national, regional, or local level, responses to disasters require extensive involvement from the medical community. Physicians have an obligation to provide urgent medical care during disasters and to maintain knowledge and skills. They are responsible for working with others to develop public health policies designed to improve the effectiveness and availability of medical services during a disaster, which is based on sound science, respect for patients, and advocates for ethically sound research to inform policy decisions (American Medical Association, 1995-2021). The role of the dental community In 2010, the first Standard Operating Manual for Emergency Preparedness and Response for State Oral Health Programs was developed in response to natural catastrophes and the need for coordinated emergency response among the dental community. The goal was to educate dental directors, staff, and collaborative partners to improve public health crisis preparedness and response capabilities. The Manual was amended in 2021 in response to the Covid-19 pandemic and applied to Washington DC and US jurisdictions and territories. A primary role by dentists in disasters has been in forensic odontology and the assistance of dental members in Disaster Mortuary Operational Response Teams (Dutta et al., 2016). Dentists serve as a source of assistance in disaster response activities and provide quality information regarding attacks,
THE ROLE OF VARIOUS HEALTHCARE PROVIDERS IN A DISASTER
Nurses represent the largest segment of the healthcare workforce (The University of St. Augustine for Health Sciences, 2021) and, as a result, impact surge capacity when responding to a disaster event (Veenema et al., 2016; Wakefield, et al., 2021). Nurse preparedness takes many forms, from ensuring that systems, procedures, and resources are readily available to facilitating relief and rehabilitation services to victims of a disaster (Wood et al., 2020). A nurse’s response is predicated upon an awareness of their role during a disaster by possessing adequate knowledge, the appropriate skill set, and the abilities to respond to all types of disasters in a timely and effective manner (Zak et al., 2020). effects of attacks, and steps to be taken in response to an attack because it is in the public’s interest that oral health and delivery of dental care services should be a priority in emergency and disaster response activity (American Dental Association, 2021; Association of State & Territorial Dental Directors, 2021). While concerns about forensics are not paramount in disaster response, it is important to think about how preserving what evidence one can will help post-disaster with identifying victims. Forensic odontology has been utilized to identify victims of many different types of disasters including earthquakes, fires, wars, tsunamis, and accidents involving ferries, trains, and airplanes. It was even used to help identify the victims of the September 11th attacks that took place in 2001 (Furnari, 2021).
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