Disaster Preparedness

Floods are the most common natural disaster globally. They occur when an area of land or a region that is usually dry is submerged under water.

• Flash Floods: Characterized by rapid onset, often occurring within minutes or hours of an intense rainfall event, dam failure, or sudden release of water.
• Riverine Floods: Result from prolonged rainfall or snowmelt that causes a river to exceed its capacity and overflow its banks.

Fires present immediate and long-term threats to health, infrastructure, and the environment.

• Wildfire: Uncontrolled fires that burn in natural areas such as forests, grasslands, or prairies.
• Structural Fires: Uncontrolled fires that occur within buildings.

These terms refer to an extensive, rotating storm system characterized by low-pressure centers, strong winds, and heavy rain. The name changes based on location (Hurricane in the Atlantic/Northeast Pacific, Typhoon in the Northwest Pacific, Cyclone in the South Pacific/Indian Ocean).

Earthquakes are the sudden shaking of the ground caused by the movement of tectonic plates beneath the Earth’s surface.

Tornadoes are violently rotating columns of air that extend from a thunderstorm cloud to the ground. They are measured using the Enhanced Fujita (EF) scale, which is based on wind speed and damage.

These are widespread occurrences of infectious diseases. An epidemic is a sudden increase in cases in a specific area, while a pandemic is an epidemic that has spread across multiple continents or worldwide.

An MCI is any event that generates more patients at one time than local resources can handle using routine procedures and care.

• Active Shooter Events: Incidents where an individual actively attempts to kill people in a confined and populated area.
• Building Collapses: The failure of structural integrity, often due to construction defects, explosions, or secondary effects of natural disasters (like earthquakes).

Chemical hazmat incidents can include such events as gas spills, industrial accidents, and toxic releases. Hazardous materials (Hazmats) are substances that pose a threat to public health or the environment. Accidental releases during transport, storage, or industrial processing (e.g., a train derailment releasing toxic gas, a chemical plant explosion) pose a risk of inhalation, absorption, or ingestion of toxic substances, leading to acute organ damage, respiratory failure, or long-term health effects.

These involve the intentional or accidental release of infectious agents (pathogens) to cause illness or death (Aminizadeh et al., 2020).

Incidents involving the uncontrolled release of radioactive material.

• Radiological: Accidental release from a medical facility or industrial source, or an intentional act using a "dirty bomb" (conventional explosives dispersing radioactive material).
• Nuclear: Detonation of a nuclear device, resulting in blast, heat, and widespread radiation fallout.

Intentional malicious acts aimed at disrupting computer systems, networks, or digital data within healthcare organizations. Ransomware, denial-of-service (DoS) attacks, or data breaches targeting Electronic Health Records (EHRs), patient monitoring systems, or hospital administration networks are on the rise.

Local agencies’ responders include Emergency Management Agencies, Fire Departments, Police, Public Health Departments, and Hospitals.

State agency responders include State Emergency Management, the National Guard, and State Health Departments.

Federal assistance is only provided after state resources have been exhausted and a formal Presidential Disaster Declaration has been issued. Federal agencies provide overwhelming resources, financial aid, and national-level coordination.

The Federal Emergency Management Agency (FEMA) is the primary federal agency responsible for responding to domestic disasters. Its mission is to assist citizens and first responders so that, as a nation, people collaborate to build, maintain, and enhance the capacity to prepare for, defend against, respond to, recover from, and reduce all hazards.

Prevention aims to prevent an incident or to intervene to stop one from occurring. Warning systems are crucial for minimizing loss of life when prevention is impossible (CDC, n.d.).

• Early Detection and Surveillance: This involves continuous monitoring for hazards.
• Public Alert Systems: These are mechanisms for the rapid dissemination of critical safety information.
• Evacuation Orders: These are directives issued by local government officials requiring people to leave a threatened area.
  • Voluntary vs. Mandatory: Voluntary evacuation suggests a threat is present; mandatory evacuation is legally enforceable and requires immediate compliance.

Public Alert System

The core of preparedness planning focuses on creating standardized, adaptable mechanisms for command and resource management (Sellers et al., 2022). Key components of this phase include the development of emergency operations plans (EOPs), incident command systems (ICS), and mutual aid agreements.

FEMA's financial assistance is the primary source of federal funding for recovery following a Presidentially declared major disaster (FEMA, 2025).

FEMA

• Housing Assistance: Grants for temporary housing (rental assistance) and funds for necessary repairs to make a primary residence habitable.
• Other Needs Assistance: Grants for essential, non-housing expenses, such as replacement of damaged personal property, medical and dental expenses, funeral expenses, and transportation costs.

Public Assistance (PA): This program provides federal grants to state and local governments, as well as certain private non-profit organizations, to quickly restore essential services and repair or replace disaster-damaged public facilities.

• Category A: Debris Removal: Funding for the collection, reduction, and disposal of disaster-related debris.
• Category B: Emergency Protective Measures: Funding for immediate actions taken to save lives and protect public health and safety (e.g., opening shelters, providing security).
• Categories C-G: Funding for permanent work, including the repair or replacement of roads, bridges, water control facilities, public buildings, utilities, and parks.

The American Red Cross is the primary non-governmental organization chartered by the U.S. Congress to provide disaster relief and support. They work closely with FEMA and local EMAs. Some of the services the American Red Cross provides include sheltering, feeding, health services, and mental health support.

Mass Care Services: Provides immediate essentials for people displaced by disasters.

1. Sheltering
2. Feeding
3. Emergency Supplies

• Health and Mental Health Services: Provides care and support within shelter environments.

Effective communication is the most critical logistical challenge in a disaster. Failure to communicate accurately and promptly can compromise safety and treatment efforts (Azarmi et al., 2022).

• Clarity and Concise (SBAR): Communication should be brief, clear, and standardized. Many organizations use the SBAR (Situation, Background, Assessment, Recommendation) framework to structure urgent medical communication, ensuring all vital information is relayed quickly.
• Redundancy: Relying on a single mode of communication is inadequate. Redundancy ensures that communications continue if a primary system were to fail. Plans must incorporate multiple backup channels, including:
  1. Radio Systems
  2. Satellite Phones
  3. Runners/Messengers

In a disaster, the first priority is to secure the scene before engaging in rescue or treatment. No responder should become a victim (Azarmi et al., 2022).

• Scene Assessment: Before entering a disaster site, a rapid assessment (size-up) must be conducted to identify ongoing hazards (e.g., unstable structures, chemical plumes, electrical hazards, active violence).
• The Responder-Victim Principle: Responders must be adequately trained, equipped (with appropriate PPE), and sheltered. If a responder is injured or becomes ill, they have now become a victim. As a result, they are removed from the response pool, requiring additional resources for their care, which compounds the problem.
• Security: Establishing a secure perimeter around the treatment or triage area is essential to prevent unauthorized access by family members, media, or looters, which could disrupt care and compromise the safety of patients and staff.

In disaster settings, complex clinical care must often be delivered outside the controlled environment of a hospital (Azarmi et al., 2022).

• Improvisation: Using available materials to create temporary splinters, bandages, or warming blankets when standard supplies are exhausted.
• Focus on Stabilization: The clinical goal in the field is rarely definitive treatment; it is rapid stabilization of the patient's immediate life threats (e.g., controlling massive hemorrhage, securing an airway) before transport to a higher level of care.

Triage in an MCI is the process of sorting patients by the severity of their injuries and their likelihood of survival with immediate care (National Library of Medicine [NLM], 2025). Unlike routine medical triage, the goal is not to treat the sickest, but to save the most lives possible.

Evacuation is the organized and planned movement of patients from a compromised facility or treatment site to a safer location (NLM, 2025).

• Facility Evacuation Planning: Hospitals and healthcare facilities must have detailed internal and external evacuation plans, including:
  1. Vertical and Horizontal Movement: Procedures for moving patients within the building (e.g., from a lower floor to a higher, safe floor) and horizontally (e.g., from one wing to another on the same floor).
  2. Order of Evacuation: Prioritizing ambulatory patients first, followed by stable critical patients, and finally the most unstable patients who require constant life support.
  3. Handoff Protocols: Standardized documentation and communication to ensure that the receiving facility is aware of the patient's condition, medications, and level of care required before the patient leaves.
• Transportation Logistics: Securing a variety of transportation modes, including ambulances, buses (for Green/Minor patients), helicopters (for critical patients or inaccessible areas), and even military vehicles. Establishing clear, secure transportation corridors is essential to preventing delays.

Red Cross shelters are temporary facilities designed to provide basic human needs to those displaced by a disaster.

• Function and Services: Provide safe, temporary lodging, mass feeding (meals and snacks), basic sanitation (toilets, washing stations), and registration services. They are designed to be temporary, operating until residents can secure longer-term housing.
• Healthcare Role: Healthcare professionals in shelters manage the non-acute medical needs of residents.
  1. Medication Management: Assisting residents in replacing lost prescriptions, coordinating with pharmacies, and ensuring the safe storage of temperature-sensitive medications (e.g., insulin).
  2. Chronic Condition Monitoring: Monitoring patients with stable chronic diseases (e.g., hypertension, diabetes) who lack access to their regular physician.
  3. Infection Control: Implementing basic hygiene measures and monitoring for communicable diseases (e.g., flu, COVID-19) that can spread rapidly in a congregate setting.
  4. Triage and Referral: Identifying residents who require definitive or acute medical care and coordinating their transport to a functioning hospital or clinic.

Respirators (N95, PAPR), gowns, gloves, eye protection.

The selection of PPE depends entirely on the specific hazard present (Hazard Vulnerability Assessment).

• Respirators: Designed to protect the wearer from inhaling hazardous airborne particles (e.g., infectious aerosols, smoke, dust).
  1. N95 Respirator: A particulate filtering facepiece that filters out at least 95% of airborne particles. Used for general airborne infectious diseases (e.g., flu, most tuberculosis).
  2. PAPR (Powered Air-Purifying Respirator): A battery-operated unit that filters ambient air and supplies it to a helmet or hood. Provides a higher level of protection than an N95 and is easier to breathe in for prolonged periods. Used for agents requiring high-level respiratory protection or when a user cannot pass a fit test.
• Gowns/Coveralls: Protect the skin and clothing from contamination. Range from fluid-resistant isolation gowns (for splash protection) to fully encapsulating, chemically resistant suits (Level A Hazmat protection).
• Gloves: Essential for preventing skin exposure. Nitrile or latex gloves are commonly used for biological/medical hazards; heavier butyl or specialized chemical-resistant gloves are required for Hazmat incidents.
• Eye Protection: Safety glasses, goggles, or full-face shields are required to prevent hazardous liquids or airborne particles from contacting the mucous membranes of the eyes.

The sequence of putting on (Donning) and taking off (Doffing) PPE is standardized and critical. Most contamination occurs during the doffing process.

• Donning Sequence (Putting On - Clean to Dirty): The general rule is to put on the items that require the cleanest contact first.
  1. Hand Hygiene
  2. Gown/Coveralls
  3. Mask/Respirator (must be checked for a proper seal)
  4. Eye Protection/Face Shield
  5. Gloves (pulled over the cuffs of the gown)
• Doffing Sequence (Taking Off - Dirty to Clean): The goal is to remove the most contaminated parts (outer surface) without touching them with unprotected skin, moving from the most contaminated areas to the least.
  1. Gloves (removed using glove-to-glove and skin-to-skin technique)
  2. Gown (removed by rolling the contaminated outer surface inward)
  3. Hand Hygiene
  4. Eye Protection
  5. Mask/Respirator (removed last, after exiting the contaminated zone)
  6. Final Hand Hygiene

Respirators (N95 and specialized masks) are ineffective if they do not seal properly to the wearer's face, allowing contaminated air to leak in.

• Fit Testing: An essential yearly process that verifies a particular respirator model and size creates a proper seal on a person's face. This can be qualitative (relying on the user's sense of taste or smell) or quantitative (using an instrument to measure leakage).
• Training: All responders must receive comprehensive training not only on the correct donning and doffing sequences but also on the limitations of their PPE, how to inspect it for damage, and when to replace it. Untrained personnel using PPE incorrectly pose a significant risk to themselves and others.

N95 Mask Fit Testing

Hazmat response planning is often categorized by the CBRNE acronym, which defines the spectrum of high-consequence threats.

• Chemical: Toxic industrial chemicals (chlorine, ammonia) or chemical warfare agents (sarin, sulfur mustard). Cause immediate physical damage (burns, respiratory distress).
• Biological: Living organisms or toxins (anthrax, ricin) used to cause illness. Effects are often delayed, complicating identification.
• Radiological: Radioactive materials that can cause contamination and radiation exposure (Cesium-137, Cobalt-60). Requires specialized detection.
• Nuclear: Large-scale release of energy and fallout from a fission/fusion device. It causes blast, heat, and long-term radiological hazards.
• Explosive (and Incendiary): Devices used to create pressure waves, fragments, and heat, often initiating secondary hazards like structural collapse or fire.

The most effective step in decontamination is simply removing clothing.

• The 80% Rule: Removing all outer clothing removes approximately 80% of surface contamination. This must be the first step,  and is often performed by the patient themselves (self-decontamination) or with assistance in the Hot Zone.
• Water-Based Showering: Patients are then directed through a decontamination corridor or shower system using high-volume, low-pressure water and mild soap. This process must be highly controlled to prevent run-off water from creating a larger environmental hazard.
• Modesty and Dignity: Protocols must balance the need for complete decontamination (which requires removing all clothing) with maintaining the patient’s dignity and privacy, often using temporary privacy screens, gender-specific staff, and disposable gowns immediately after washing.