Introduction

When hearing about emergency preparedness and responses, what comes to mind? If you’re a nurse, you’ve heard of emergency response before. You have probably heard of or worked in emergency room settings, hospitals, or experienced an emergency before.

Whether it’s a natural disaster, a cybersecurity incident at work, or your roof collapsing at home, emergencies can happen anytime and anyplace. Between patient care, nursing scope of work regulations, and all things influencing daily activities in this world, there is always the possibility of an emergency arising near you. The information in the course will serve as a valuable resource for nurses regarding emergency preparedness.

Defining Emergencies 

Emergencies are typically defined as situations that are outside the norm. For instance, an emergency could be a tornado striking your hometown and causing a surge of injured patients in the local urgent care center. Another emergency could be if you go to work one day and cannot access your patients’ electronic health records (EHR) because of a sudden cybersecurity incident.  

Another type of emergency could be a mass shooting at a local school, in which the local hospital might have an increased number of pediatric patients to care for. Emergencies can occur at your workplace, home, and community. They can affect you, your health, your community, and your finances professionally and personally. Since nurses are the largest group of healthcare workers in the United States and several parts of the world, nurses are often at the forefront of several types of emergencies, even outside the emergency room settings (1). 

Given the vast range of emergencies, nurses’ roles in healthcare settings, and the ever-growing world of technology and population shifts, emergency preparedness is an essential skill for nurses.  

Emergency Identification 

Emergency identification is one of the core concepts for emergency preparedness. Most people have emergency alerts already pre-set on their cell phone devices. Be sure to check with your local cell phone provider and cell phone itself to see if this is enabled on your phone plan.  

In addition, your workplace should have an emergency alert system, especially for nurses in direct patient care. Suppose you need clarification on your workplace’s emergency alert protocols. In that case, you can follow up with your supervisor or the public safety department to ensure you are informed of emergency alert protocols in an emergency. 

Also, local weather and news alerts can provide insight into local emergencies that could influence patient flow and volume. That said, it is unrealistic to watch weather patterns and news consistently to be aware of everything in your area. Checking the weather daily or installing a weather application on your phone or laptop can keep you updated on weather-related emergencies, such as thunderstorms or earthquakes.  

Likewise, with many things in the news, knowing every possible emergency in your area is impossible. Keeping track of local news at your own pace is something you can do at your discretion to be aware of any political movements or social events that can influence possible emergencies.  

A shelter plan is needed if people are displaced due to an emergency, such as war, famine, natural disaster, or another situation. Hospitals, community health centers, and public health departments are often used as emergency shelters. If you are a nurse working for a hospital, community health center, or public health department, you can review whether your place of work has a shelter plan.  

You can speak to your supervisor or the public safety department if you need to know your workplace’s shelter plan. It is essential to know if your workplace has a protocol for shelter in place or a shelter plan, since nurses are often the primary workers at the forefront of shelter care (2). Research has shown that nurses frequently report feeling overwhelmed and under-supported in emergencies, so proper education and communication with your workplace are essential for emergency preparedness.  

In addition, depending on the type of emergency, an evacuation route might be a possible emergency preparedness option to consider. For instance, what would you do if there were a fire on the second floor of a hospital and you were working on the fifth floor? How would you evacuate your patients? How would you obtain your items? How would you be notified? What is your role in this situation? 

Given the various roles and places of work for nurses, understanding your workplace’s evacuation route and plan is essential for your safety, as well as that of your patients and co-workers. If you are unaware of your workplace’s evacuation plan or route, ask your supervisor or the public safety department (2). Generally, it is essential to ensure you are aware of evacuation routes in your workplace, communication protocols, and emergency preparedness guidelines.  

Nursing Role Identification

Nurses play such a critical role in health care, and health care during emergencies is no exception. Several studies have noted the essential role of nurses in emergencies, yet studies also note that nurses are often uninformed, overwhelmed, and traumatized after emergencies (1, 2, 3).

You can also verify your scope of work as a nurse with your workplace and local regulations during an emergency, as some jurisdictions and workplaces alter the scope of work for nurses in emergencies. In addition, if you are deployed to work in an emergency setting in another part of the United States or another country, your scope of work might vary as well. Several workplaces might also designate certain nurses to different roles in the event of an emergency, similar to nurses’ roles in a code setting. Such roles can vary, including triage, direct patient care, documentation, grief support, etc.

To be aware of your specific role in an emergency, it is recommended to take emergency preparedness courses, stay updated on your workplace’s emergency policies, and review your nursing scope of work within your place of work and state.

Also, be sure to ask your workplace for any resources for nurses working in an emergency, such as technical support, documentation support, mental health support, crisis support, and financial support, depending on the extent of the emergency.

Patient Health Information (PHI) Protection

Patient health information (PHI) is any information related to a patient, such as their contact information, demographic information, health history, imaging studies, lab results, etc. PHI is everywhere in healthcare. From multiple screens in operating rooms to patients accessing their patient portals on their phones, PHI is a serious concern (4).

That said, in emergencies, depending on the nature of the emergency, PHI is often exposed, lost, or documented incorrectly. If an emergency eliminates Internet or EHR access, consider using workplace and Health Insurance Portability and Accountability Act (HIPAA) compliant paper documentation. If an emergency compromises PHI, such as a cybersecurity incident or a fire that destroys workplace equipment, immediately notify your supervisor and information technology (IT) staff.

Furthermore, every workplace has its protocols regarding electronic and hardcopy documentation. Depending on the nature of the emergency, hardcopy documentation might be more commonplace, resulting in possible complications in accessing the entire patient history, performing cross-functional care between various healthcare professionals, and verifying insurance and other legal documentation.

It is essential to speak with your supervisor regarding documentation and patient care practices for your workplace in emergencies, as protocols can vary significantly by place of work. Here are some general tips on PHI protection for nurses in the event of an emergency:

• Do not ever share PHI outside of the workplace
• Do not ever share PHI on social media
• Do not ever email PHI, including within your organizational email
• Do not share PHI with anyone other than health care staff directly involved in patient care and people listed explicitly on the patient’s records who have access to the records
• If a patient needs to update their contact information or demographic information, make sure they are logged into their account, or you can contact the appropriate staff to assist with changing their PHI
• If you receive a request for PHI, such as labs or imaging, to be sent somewhere, confirm that this is a legitimate source asking for the information, such as another staff member involved in direct care. When in doubt, refer to your organizational policies, supervisor, or IT department

Emergency Preparedness Safety for Nurses and Patients

Almost every nurse in a primary health care system will experience some emergency in their professional or personal life. Whether it is a fire at your workplace or a natural disaster affecting your loved ones, there are some general things to consider when considering safety and preparedness.

First, whether it is in the workplace or at home, make sure there is an established chain of communication. Ensure you are up to date with any of your workplaces’ emergency alerts. Ensure your household members receive emergency alerts and can contact each other.

Second, ensure you know where the emergency kit resides in the workplace or home. Depending on your place of work, you can ask for the location of the emergency supply bin, box, or cart. A nurse will often be designated to check the supplies for patency and expiration per workplace policy. At home, you can create a personalized emergency preparedness kit consisting of prescription medications for your household members, flashlights, water, dry food, and other pertinent supplies. Several pre-made emergency preparedness kits are available; however, creating a customized kit for your household is ideal since everyone’s home has different needs.

Third, whether in the workplace or at home, it is essential to consider any medical needs for you, your patients, and your loved ones. If you have any chronic health conditions or seek routine health care, make sure you have medications and support to sustain yourself in an emergency.

Several workplaces will also offer crisis counseling, grief support, and financial hardship stipends in emergencies, so be sure to ask your supervisor or human resources (HR) department about workplace specifics. In addition, if you live in a household with people or pets with health conditions, such as asthma or diabetes, ensure they know their prescription medication statuses, have alternative medical supplies if needed, and have access to routine health care services.

Nursing Considerations

What Is the Nurse’s Role in Emergency Preparedness? 

Nurses remain the most trusted profession for a reason. They are often pillars of patient care in several healthcare settings. Patients turn to nurses for guidance, education, and support. While there are no specific guidelines for nurses’ roles in emergency preparedness, here are some suggestions for providing quality patient care and ensuring their safety (1,2,3).

1. Know where your devices are at all times. Often, with patient care, especially in hectic care settings, you can lose sight of your computer, personal phone, work phone, and more. With hundreds of people in and out of hospitals and other healthcare places every hour, consider adding a Find Your Device option to every device you bring to work. This might be lifesaving and critical in an emergency, especially if the emergency affects telecommunications and electricity.
2. Be aware of your surroundings. Know where the fire escapes, emergency exit routes, and emergency kits are located in your workplace and home situation. If you are still getting familiar with your workplace’s safety routes or emergency supplies’ location, consider contacting your supervisor.
3. Stay up to date with your organization’s latest emergency preparedness training and continuing nursing education, if applicable.
4. Communicate any concerns you have about safety and emergency preparedness with a supervisor. Ensure you have assigned roles and responsibilities, particularly if you work in patient care in an emergency.
5. If you have experience working as a nurse in an emergency, consider seeking support during or after the experience, as mental, physical, and psychological health can influence you after this experience.
6. Ensure your household members are on the same page regarding a response to an emergency.

How can nurses identify if there is an emergency?  

Unfortunately, it is not possible to know when every single emergency will occur. Nurses can be aware of potential natural disasters by checking the local weather and possible socially created disasters by checking the local news. That said, if there is an emergency situation, you can speak to your supervisor about your possible concerns.

What should patients know about emergency preparedness?   

Patients should know that anyone can experience an emergency. Here are essential tips for patient education regarding emergency preparedness in the inpatient or outpatient setting.

• Keep your devices, including apps, updated.
• Make sure you have at least two weeks’ worth of medications
• Keep up to date with your immunizations
• Have emergency personal protective equipment (PPE), such as masks and gloves
• Review free resources on emergency preparedness from your local public health department or reputable sites, such as ready.gov
• Ensure you securely store your essential documents, such as your passport and insurance card.
• Ensure that every person in your household, including your pets, has water and non-perishable food for at least one week.

Case Study

Beth is a 34-year-old nurse who was a nurse educator in a community health clinic a few weeks ago. She typically works on the second floor, but because of some renovations, she is working on the third floor this week. While educating a patient on asthma medications, she faintly smells smoke. Beth is aware of a no-smoking policy in the workplace, so she continues educating her patients.

After her patient education session, she notices the smell of smoke increasing. She looks around, and she notices that other people are starting to see the smell of smoke as well. Beth is a new employee who knows construction occurs on the first and second floors and does not want to cause a scene. However, Beth is concerned with the increase in smoke. She looks out the window and sees smoke from the first floor.

Beth is shocked at the smoke and checks her work email and phone. She needs an update from her supervisor or HR, and assumes the smoke results from construction downstairs. She notices some other co-workers coughing more aggressively, so Beth calls her supervisor.

Beth’s supervisor does not answer the phone, and one of Beth’s new patients has just arrived for a nurse educator consultation. Beth knows this patient has a history of asthma and has mobility concerns. Beth tells her patient to sit in the waiting area and calls her supervisor again. Her supervisor picks up the phone and says, “THERE IS A FIRE ON THE SECOND FLOOR. EVACUATE IMMEDIATELY.” A few seconds later, a massive fire alarm goes off in the building.

Beth called 911 from her personal cell phone and informed her co-workers and patient of the situation. With the assistance of her other co-workers, Beth was able to help her patient down the flight of stairs. Ultimately, the fire started 20 minutes ago, and it took the fire department about 30 minutes to eliminate it.

This incident was featured on the local news, and Beth’s loved ones reached out to her to ask if she was OK. Beth tells them she is fine, but she feels uneasy. A few days later, Beth also reached out to her supervisor and HR and asked for the next steps regarding emergencies in the workplace, as she felt unprepared in this situation.

Conclusion

Emergencies are a part of every life. Knowing about emergency preparedness options and care for you and your household members is essential.