Since September 11, 2001, communities have searched for strategies to protect their residents from biological, chemical, and nuclear terrorist attacks and other public health emergencies. They have received federal grants to buy communication and other disaster response equipment, collaborated with agencies to conduct disaster drills, and attempted to prepare families to care for themselves in the early days of a disaster. As communities have planned for pandemic influenza, the strategies that work for typical disasters must be revised to fit the characteristics of an infectious disease outbreak. For example, large community shelters will be inappropriate, since crowded conditions would increase the chances of spreading the illness. Families will need to stockpile food, water, and other supplies, in case they are quarantined or nearby stores are empty because of delayed or absent transportation resources. Communities will need to establish effective surveillance systems to allow early identification of outbreaks. In this issue, Persell and Robinson review the complexities of syndromic surveillance.
In the past 125 years, the American Red Cross (ARC) has been legendary in providing consistent, compassionate care to individuals, families, and communities during and after disasters. Whether it is a single-family fire or a regional flood, the ARC is there providing food, shelter, and comfort. When a community is hit by a disaster and does not have an ARC chapter or sufficient numbers of local volunteers, the regional or national level of the ARC quickly mobilize volunteers from other areas of the country not directly affected by the disaster.
During the past few years, the skills and resources of the ARC have been stretched to the maximum during major disasters such as hurricanes Katrina, Rita, and Wilma in 2005. Many states receiving evacuees did not have enough volunteers to staff the shelters established by the ARC. In Arkansas, when the number of evacuees peaked at more than 70,000, Governor Mike Huckabee requested the churches in the state to open additional shelters in their camps. This successful effort is described by Hoffpauir and Woodruff, who focus on the provision of mental health services to the residents of these camp shelters.
Another challenge during the 2005 hurricane season was the inability to track many of the 1.5 million people displaced from the gulf coast. Some families were separated for months because they were arbitrarily loaded on to buses and sent to shelters in different states, and then moved several times from shelter to shelter, even state to state. Shelters that were not operated by the ARC did not consistently use the well-established procedures used by the ARC to track shelter residents. Pate reviews the literature exploring the state-of-the-art tracking devices that might be used to track evacuees or identify corpses after mass casualty incidents.
As communities prepare for future disasters, they need to identify their current resources such as evacuation or transportation assets. Waiting until the disaster hits is too late. One tool available is geographic information system (GIS) software, which can aid in the collection, processing, and analysis of data. Abbott demonstrates the use of GIS in evaluating the availability of air and ground ambulances for emergency response in Arkansas. Similar models may be established for assessing other community resources.
Disasters are particularly stressful for vulnerable populations such as children, the elderly, and individuals with disabilities and other special needs. Communities must identify these special needs and develop strategies to meet them during and after disasters. Gaffney thoroughly explores the mental health effects of catastrophic events on children and adolescents, and shares multiple resources to assist this special population.
Community infrastructures include educational facilities, industries, shopping areas, healthcare facilities, recreational areas, and many other components. After a major disaster, these community resources must be rebuilt in order for the community to survive and retain its identity. The 2005 hurricane season destroyed or severely damaged many community resources along the gulf coast, including the Louisiana State University Health Sciences Center in New Orleans. Chauvin et al describe the heroic efforts of faculty, staff, and students to salvage and rebuild this historic institution. The lessons they learned and share in this journal may help other institutions survive and rebuild after future disasters.
The major focus of this issue of it Family Community Health is preparing communities for disasters. The authors describe strategies to detect bioterrorism events, track victims and evacuees during and after disasters, assess community resources through computer programs such as GIS, promote the mental health of people affected by disasters, especially children and adolescents, and rebuild the community infrastructure postdisaster.
Communities also consist of businesses and community organizations. Protecting these resources through continuity of operations during and after disasters is critical for community survival. Many entrepreneurs have developed strategies to help businesses and organizations mitigate the effects of disasters by appropriate planning. In the final article, Hipple describes a technique called predictive failure analysis, which differs from the usual "checklist" approach of disaster preparedness.
Space constraints prohibit the inclusion of every possible topic about preparing communities for disasters, but the articles included provide a broad spectrum of topics. Every reader should assess his or her own community to determine its readiness for disasters, and participate in community efforts to fill in the gaps. During the early days of any large disaster, each individual and family must be prepared to survive without outside help. Communities must also prepare for survival without depending upon state or national assistance, especially if a widespread emergency such as pandemic influenza occurs, prohibiting neighboring communities and states from offering mutual aid. For additional information, readers should consult useful government Web sites such as http://www.cdc.gov and http://www.fema.gov, as well as nonprofit organizations such as the American Red Cross (http://www.redcross.org) for tools to prepare for specific disasters.
The author thanks the following individuals who served as special reviewers in addition to selected reviewers from the Family & Community Health Editorial Board: Faculty at Arkansas State University: Deborah Persell; Faculty in the University of Arkansas for Medical Sciences College of Nursing: Susan Ball, Janice Dean, Robin Easley, Shannon Finley, Victoria Grando, Joy Jennings, Robert Kennedy, Elaine Souder, and Janice Taylor; members of the Arkansas Department of Health Bioterrorism Advisory Committee Special Populations Workgroup: Douglas Brown, Margo Bushmiaer, Rick Ihde, and Bettye Watts; and Nancy McKelvey, Chief Nurse of the American Red Cross.
Cheryl K. Schmidt, PhD, RN, CNE, ANEF, Issue Editor
Associate Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, (e-mail: mailto:[email protected])