Disaster Nursing and Emergency Preparedness: For Chemical, Biological, and Radiological Terrorism, and Other Hazards, Fourth Edition

“What a wonderful resource!" --Doody's Medical Reviews “The 4th Edition is unique in recognizing the rapid changes in both the causes of crises and the latest attempts to provide timely multidisciplinary approaches to the practice of this growing specialty…Evident throughout this edition is the call to identify crisis leadership among the increasingly talented base of nurses who have responsibility to move the profession to recognize and accept that they can be advocates for better planning, coordination, education and training.” - Frederick M. Burkle, Jr., MD, MPH, DTM, PhD(Hon.), FAAP, FACEP Senior Fellow & Scientist, Harvard Humanitarian Initiative, Harvard University & T.C. Chan School of Public Health From the Foreword “This impressive edition builds upon the solid foundation of the first three award-winning editions with an expanded focus on climate change related disasters, globalization and its implications for emerging and re-emerging infectious diseases, the accommodation of high-risk, high-vulnerability populations, and the potential for disaster arising from a world witnessing increasing community violence and civil unrest.” -Patricia M. Davidson, PhD, MED, RN, FAAN Professor & Dean, Johns Hopkins School of Nursing From the Foreword “The contributing authors read like a “Who’s Who” of disaster leaders. They lend their special expertise and insights, which are supported and elucidated by cogent learning strategies in the use of case studies, student questions, and packed content in all areas of disaster participation, preparedness, policies, and research. For over 16 years [this book] has been the hallmark text in its field and this edition proves to be the best ever.” -Loretta C. Ford, RN, PNP, EdD Dean Emeritus, University of Rochester School of Nursing Founder of the National Nurse Practitioner Program Member, National Women’s Hall of Fame Featuring the most current, valid, and reliable evidence-based content available, this three-time AJN winner once again presents an unparalleled resource for disaster and emergency preparedness. Disasters lay heavy burdens upon healthcare systems that stretch all levels of society. While natural and man-made disasters are not new, the global nature, rate, type, and totality of their impact has only increased. The fourth edition of this foundational text uniquely addresses the rapid changes in these crises and analyzes the latest attempts to provide timely, multidisciplinary healthcare. Nurses consistently comprise seventy or more percent of responders to local, national, regional, and global crises, and represent a potentially untapped resource to achieve surge capacity goals and optimize population health outcomes. Considering recent world events and increasing geopolitical tensions, Disaster Nursing and Emergency Preparedness, Fourth Edition now features expanded content on the ubiquitous threat of terrorism, potential detonation of thermonuclear weapons, emerging and reemerging infectious diseases, and increasing frequency and intensity of natural disasters from climate change. This text promotes competency-based expert nursing care during disasters and positive health outcomes for small and large populations consistent with the Federal Disaster Response Framework. Whenever possible, content is mapped to published core competencies for preparing health professions’ students for response to terrorism, disaster events, and public health emergencies. The fourth edition retains the clearly organized format in each chapter that includes an overview, learning objectives, a summary, and case study with reflective questions. New to the Fourth Edition: Addresses the most recent landmark agreements Sendai Framework for Disaster Risk Reduction 2015–2030, the United Nations’ Sustainable Development Goals, and the Paris Climate Agreement Covers public health emergencies involving community violence and civil unrest Expands coverage of planning for and accommodating high-risk, high-vulnerability populations Aligns with the U.S. National Health Security Strategy and the National Planning Frameworks Provides focused content on medical countermeasures Includes an improved instructor package with guide, PowerPoint slides, and case studies with questions for reflection in every chapter Cover Title Copyright Brief Contents Contents Contributors Reviewers Foreword Foreword Foreword Preface How to Use This Book Guidelines for Nursing Faculty and Staff Development Specialists Update on What Is New in the Fourth Edition Key Features of the Fourth Edition Digital Instructor’s Guide Disaster Content Rubric Editor’s Note Share Disaster Nursing and Emergency Preparedness: For Chemical, Biological, and Radiological Terrorism, and Other Hazards, Fourth Edition Section I: Disaster Preparedness Chapter 1: Essentials of Disaster Planning Chapter Overview Definition and Classification of Disasters Declaration of a Disaster Health Effects of Disasters The Disaster Continuum Disaster Planning All Hazards Disaster Planning Disaster Planning and Public Health Preparedness Hazard Identification, Vulnerability Analysis, and Risk Assessment Evaluating Capacity to Respond Core Preparedness Activities Evaluation of a Disaster Plan Situations Suggestive of an Increased Need for Planning Professional Nursing Mandate Summary Study Questions References Chapter 2: Leadership and Coordination in Disaster Healthcare Systems: The U.S. National Preparedness System Chapter Overview Federal Preparedness Planning and Emergency Response National Planning Frameworks National Response Framework The NRF as It Relates to the NIMS Implementation of the NRF Roles and Responsibilities Federal Definition of a Disaster Condition NRF Considerations Federal Medical Response Resources Medical Response Actions A Blueprint for the Future for Disaster Nursing Leadership All Disasters Are Local Crisis Standards of Care for Use in Disaster Situations Resources for Disaster Planning Summary Study Questions References Chapter 3: Hospital and Emergency Department Preparedness Chapter Overview Hospital Preparedness Phases of Emergency Planning Disaster Standards of Care Hospital Disaster Planning Alternate Care Sites Communication and Information Technology Issues Hospital-Based Decontamination and Pediatric Considerations Summary Study Questions References Chapter 4: Emergency Health Services in Disasters and Public Health Emergencies Chapter Overview The EHS System Major EHS Concepts Associated With Disasters Resources for the EHS System Patients’ Access to EHS During a Disaster Major EHS Issues Summary Critical Actions Study Questions References Chapter 5: Emergency Medical Consequence Planning for Special Events, Mass Gatherings, and Mass Casualty Incidents Chapter Overview Mass Gatherings and Special Events Healthcare Emergency Management Emergency Medical Consequence Planning Predicting Patient Presentation Rates Event Type Weather Event Duration Characteristics of the Crowd Alcohol and Drug Usage Medical Aid Stations Transportation Considerations Communication Systems Staffing Documentation Mass Casualty Incidents Practice Parameters for Nursing Care Summary Study Questions References Appendix 5.1 No-Notice Incidents: Hospital Triage, Intake, and Throughput Chapter 6: Legal and Ethical Issues in Disaster Response Chapter Overview Legal and Ethical Framework and Background Effect of Law on Nursing Professionals Relationship Between Ethical and Legal Obligations Proposed Model State Acts The Role of Government in a Public Health Crisis Specific Legal and Ethical Issues Summary Study Questions References Section II: Disaster Mental Health and High-Vulnerability Populations Chapter 7: Identifying and Accommodating High-Risk, High-Vulnerability Populations in Disasters Chapter Overview Defining and Understanding Vulnerability Using an Equity and Empowerment Lens The Life Cycle of Disasters Examples Organized Around the Ecosystem Model Summary References Additional Resources Case Study 7.1 Case Study 7.2 Case Study 7.3 Appendix 7.1 The Post-Disaster Personal Assessment Tool Appendix 7.2 Think Before You Speak or Write: Polite Communication Chapter 8: Human Services in Disasters and Public Health Emergencies: Social Disruption, Individual Empowerment, and Community Resilience Chapter Overview Human Services “Under Clear Skies” Human Security What is Social Well-Being? Empowerment Human Services in Disaster Response and Recovery Theories Supporting the Role of Nurses in Human Services The Role of Nurses in Human Services Case Management in Disasters Summary Study Questions References Case Study 8.1 Chapter 9: Understanding the Psychosocial Impact of Disasters Chapter Overview Bioterrorism and Toxic Exposures Community Impact and Resource Assessment Normal Reactions to Abnormal Events Special Needs Populations Community Reactions and Responses Summary Study Questions Internet Activities Useful Links References Case Study 9.1 Case Study 9.2 Chapter 10: Management of the Psychosocial Effects of Disasters Chapter Overview The Mental Health Response Team Recruitment, Screening, and Training Disaster Mental Health Interventions Acute Stress Disorder Posttraumatic Stress Disorder Interventions With Special Populations Fatigue Management When Grief and Stress Go Awry Traumatic Grief (Complicated Bereavement) Critical Incident Stress Management Summary Study Questions Internet Activities Useful Links References Chapter 11: Unique Needs of Children During Disasters and Other Public Health Emergencies Chapter Overview Epidemiology of Pediatric Injuries and Illnesses During Disasters and Public Health Emergencies Physiological Considerations in Pediatric Care Following a Disaster or Public Health Emergency Children With Functional and Access Needs Psychosocial Considerations in Pediatric Care Pediatric Care During Disasters Pediatric Care During Public Health Emergencies Ethical and Legal Considerations in Pediatric Disaster Care Pediatric Death Following Disasters and Public Health Emergencies Planning for Disasters—Pediatric-Specific Considerations Summary Study Questions Internet Activities Support Preparedness References Chapter 12: Disaster Nursing in Schools and Other Community Congregate Child Care Settings Chapter Overview Growth and Developmental/Cognitive Considerations Summary Study Questions Internet Activities References Appendix 12.1 Index to Recommendations and Responsible Entities Chapter 13: Care of the Pregnant Woman and Newborn Following a Disaster Chapter Overview Physiology of Normal Pregnancy Pregnancy During Disaster Conditions Complications of Pregnancy Assessment of the Pregnant Woman and Baby Childbirth During Disasters Complications of Labor and Delivery: Malpresentation Care of the Umbilical Cord Special Assessment/Conditions of the Newborn Postpartum Management in Disasters Special Considerations for Mother and Baby in Disasters Infections and Communicable Diseases Environmental Cleanliness and Sanitation Bioterrorism Trauma in Pregnancy Breastfeeding and Infant Nutrition Lack of Food, Malnutrition, and Starvation Crisis Conditions Associated With Pregnancy Infections in Postpartum and Lactating Women During Disasters Shelters and Practical Considerations for Austere Environments Death of the Mother or Infant—Bereavement Concerns and Interventions Returning Home Safely Risk of Violence, Abuse, Slavery, and Human Trafficking Posttraumatic Stress Disorder Summary References Appendix 13.1 Breastfeeding: A Vital Emergency Response. Are You Ready? Section III: Global Disasters and Complex Human Emergencies Chapter 14: Disaster Nursing and the United Nations 2015 Landmark Agreements—A Vital Force for Change in the Field of Disaster Nursing Chapter Overview Disasters and Their Impacts The 2015 UN Landmark Agreements The Sendai Framework for Disaster Risk Reduction Roles and Responsibilities of Nurses in Implementing the Sendai Framework How Can Nurses Actively Engage in and Lead on Disaster Risk Reduction and Disaster Risk-Management Policy Nationally and Globally? Role of the World Health Organization Who Collaborating Centers Summary Study Questions Acknowledgments Useful Links References Chapter 15: Complex Humanitarian Emergencies Chapter Overview Defining CHEs Major Characteristics International Response Measuring the Human Cost Assessments, Data Collection, and Analysis Epidemiological Models Postconflict Phase Consequences Shifting Aid From Rural to Urban Environments Future Complex Humanitarian Emergencies Professionalization of the Humanitarian Workforce Summary Study Questions References Additional Resources Chapter 16: Nursing in Disasters, Catastrophes, and Complex Humanitarian Emergencies Worldwide Chapter Overview Scale of Disasters Worldwide Growth of Aid Agencies and Contribution of Nursing Development of an International Workforce Ethical Issues in Disaster Nursing Communication and Transport as Obstacles to Aid Relief Care of Displaced Persons and Refugees Summary Study Questions References Chapter 17: Natural Disasters Chapter Overview Types and Consequences of Natural and Environmental Disasters Cyclones, Hurricanes, and Typhoons Drought Earthquake Epidemics Flood Heat Wave Tornado Thunderstorms Tsunamis Volcanic Eruptions Winter/Ice Storms Wildfires Summary Study Questions Internet Activities References Case Study 17.1 Case Study 17.2 Case Study 17.3 Chapter 18: Environmental Disasters and Emergencies Chapter Overview Environmental Emergencies Environmental Disasters Environmental Public Health Tracking: Protecting Communities Through Integrated Environmental Public Health Surveillance Environmental Protection Agency CDC National Environmental Public Health Tracking Network Examples of Environmental Hazards and Their Impact Summary Study Questions Internet Activities References Case Study 18.1 Case Study 18.2 Case Study 18.3 Case Study 18.4 Case Study 18.5 Case Study 18.6 Case Study 18.7 Chapter 19: Restoring Public Health Under Disaster Conditions: Basic Sanitation, Water and Food Supply, and Shelter Chapter Overview Basic Public Health Functions Health Promotion Maslow’s Hierarchy of Needs Risk Factors for Infectious Disease Outbreaks From Disasters Rapid Assessment of Population Health Needs The Sphere Project Foodborne Illness Summary Study Questions Acknowledgment References Appendix 19.1 The Essential Functions of Public Health Chapter 20: The Role of the Public Health Nurse in Disaster Response Chapter Overview The Unique Contribution of the PHN Role of the PHN in a Disaster Role of the PHN in Prevention and Health Education Role of the PHN in a Biological Event Role of the PHN in Infectious Disease Emergencies Role of the PHN in Medical Countermeasure Dispensing Role of the PHN in a Chemical Disaster Role of the PHN in a Radiological Event Role of the PHN on a Multidisciplinary Response Team Summary Study Questions References Chapter 21: Climate Change and Health: The Nurse’s Role in Policy and Practice Chapter Overview Physical Drivers of Climate Change Selected Health Outcomes Vulnerable and Susceptible Populations The Nurse’s Role in Climate Change Future Work to Be Done Summary Study Questions Useful Links References Section IV: Disaster Response Chapter 22: Disaster Triage Chapter Overview Basic Principles of Disaster Triage Phases of Disaster Triage: From the Field to the Hospital Basic Differences Between Daily Triage and Disaster Triage at the Hospital Prehospital Disaster Triage Triage Tags The Job of the Triage Officer Disaster Triage for Hazardous Material Disasters Summary Study Questions References Chapter 23: Disaster Management Chapter Overview Classifications of Disasters The Role of Leadership The Disaster Management Process Introduction to Hospital Incident Command System Communication During an Emergency Event Recovery Evaluation and Follow-Through Summary Study Questions Useful Links References Chapter 24: Public Health Emergencies Involving Community Violence and Civil Unrest: Taking Planned Action Chapter Overview Civil Unrest Ferguson, MO Social Issues as Foundational Elements in Civil Unrest Active Shooter Types of Active Shooters Mitigation and Preparedness Response Active Shooter Management in the Prehospital Setting Recovery Community Resilience Mental Health Support Ethics Considerations for Nurses in Mass Shootings Considerations for Nurses in Civil Unrest Summary Study Questions Useful Links References Chapter 25: Management of Burn Mass Casualty Incidents Chapter Overview Preparedness/Planning Mitigation Response Recovery Evaluation Summary Acknowledgments Study Questions References Case Study 25.1 Case Study 25.2 Case Study 25.3 Chapter 26: Traumatic Injury Due To Explosives and Blast Effects Chapter Overview Explosives: Classification and Physics Mechanisms and Patterns of Injury Blast Injuries and Clinical Care of Survivors Military and Civilian Casualties Extremes of Ages and Pregnancy Event Management Summary Study Questions References Case Study 26.1 Case Study 26.2 Chapter 27: Caring for Patients With HIV Following a Disaster Chapter Overview The Sphere Project and Minimum Standards Reproductive Health and Sexually Transmitted Diseases Clinical Considerations in Caring for Patients With HIV and AIDS Special Considerations in Children and Pregnant Women Psychological Considerations of Caring for Patients With HIV Summary References Case Study 27.1 Case Study 27.2 Section V: Disaster Caused by Chemical, Biological, and Radiological Agents Chapter 28: Biological and Chemical Terrorism: A Unique Threat Chapter Overview Chemical Terrorism and Bioterrorism Defined Why Would Terrorists Use Chemical or Biological Agents? Chemical Terrorism Bioterrorism Case Examples Mass Psychogenic Illness Summary Study Questions References Chapter 29: Chemical Agents of Concern Chapter Overview HAZMAT Incidents Chemical Agents in the Environment HAZMAT Emergency Response Detection of Chemical Agents Chemical Agents of Concern Medical Countermeasures Medical Management of HAZMAT Victims Nerve Agents Vesicating/Blister Agents Blood Agents Pulmonary/Choking Agents Riot Control Agents Emergency Department Procedures in Chemical Hazard Emergencies Summary Study Questions Internet Activities References Case Study 29.1 Case Study 29.2 Chapter 30: Biological Agents of Concern Chapter Overview Classification of Biological Agents of Concern Biosafety Laboratory Classification Anthrax Botulism Plague Tularemia Smallpox Viral Hemorrhagic Fevers Summary Study Questions References Chapter 31: Surveillance Systems for Detection of Biological Events Chapter Overview Background How is Disease Occurrence Measured? What is Public Health Surveillance? What Types of Systems Are Used to Collect Surveillance Data? What Are the Roles of State and Local Health Departments in Disease Surveillance Systems? What is the Role of Clinicians in Infectious Disease Surveillance? What is Biosurveillance? What is the Role of Animal Surveillance Systems? How Do Emergency Information Systems Fit Into a Biosurveillance System? Early Recognition and Detection of Biological Events: Role of the Clinician Epidemiological Approach to Biological Event Recognition Syndrome-Based Approach to Biological Event Recognition Laboratory Detection of Biological Events Lessons Learned and Future Directions Summary Study Questions Internet Activities References Chapter 32: Infectious Disease Emergencies Chapter Overview Infectious Diseases and Emergencies Brief History The Burden of Infectious Disease Factors Contributing to the Spread of Infectious Diseases Diseases of Importance Future Directions Study Questions References Chapter 33: Medical Countermeasures Dispensing Chapter Overview The Division of Strategic National Stockpile Radiological Countermeasures Shelf Life Extension Program (SLEP) Organizing to Respond Structuring Dispensing Programs Cities Readiness Initiative Medical Countermeasures Planning Elements The Public Readiness and Emergency Preparedness Act Vaccine Storage and Handling Pediatric Countermeasures Planning Cross-Jurisdictional Planning Summary References Case Study 33.1 Chapter 34: Radiological Incidents and Emergencies Chapter Overview Radiation Basics Health Effects of Radiation Exposure Radiological Incidents and Emergencies Medical Response to Nuclear and Radiological Terrorism Questions to Ask When Receiving and Caring for Radiological Patients Contents of a Contamination Control Kit Study Questions Internet Activities References Chapter 35: Decontamination and Personal Protective Equipment Chapter Overview Triage of Contaminated Patients in the Field Decontamination for Chemical Warfare Agents Patient Decontamination Pediatric Considerations Evacuation of the ED Supportive Medical and Nursing Care Seizures Summary Study Questions Hotlines/Helplines References Section VI: Special Topics in Disasters Chapter 36: U.S. National Disaster Nurse Readiness: Practice and Education for a Prepared Workforce Chapter Overview Rationale for a Prepared Nursing Workforce Practices of a Prepared Nursing Workforce Educating a Prepared Nursing Workforce Supporting Evidence-Based Disaster-Nursing Practice Society for the Advancement of Disaster Nursing Summary Study Questions References Chapter 37: American Red Cross Disaster Health Services and Disaster Nursing: National Capability—Local Community Impact Chapter Overview Congressional Charter International Red Cross and Red Crescent Movement American Red Cross Historical Background Overview of American Red Cross Disaster Cycle Services American Red Cross Disaster Partners American Red Cross at the Local, Regional, and National Levels Red Cross Nursing Role of the American Red Cross Nurse During a Disaster Shelter Nursing—The Art of Disaster Care Summary References Chapter 38: Directions for Disaster Nursing Research and Development Chapter Overview Conceptual Frameworks for Disaster Nursing Research Crisis Conceptual Nursing Model Merits of Models Implications for Using Models for Disaster Nursing Research Complexities Conducting Disaster Research Future Nursing Research Agenda and Policy Implications Summary Study Questions Internet Activities References Case Study 38.1 Case Study 38.2 Chapter 39: Improving Children’s Health Outcomes Through Pediatric Disaster Research and Policy Chapter Overview Why Are Children’s Responses Different From Adults in Disasters? Researching Children Experiencing Disasters Children’s Reactions to Disaster Parental Influences on Children’s Reactions to Disasters Research-Based Interventions With Children Exposed to Disasters Pediatric Perspectives on Disaster Preparations Summary References Chapter 40: Information Technology in Disaster Management Chapter Overview Information and Disaster Management Information Management and Processing Logistics and Resource Management Decision Support Systems Early Warning Systems Telemedicine The Internet as a Disaster Management Resource Summary References Epilogue: Disaster Recovery: Creating Healthy, Resilient, and Sustainable Communities After Disasters Recommendations for Disaster Recovery in the United States Social Determinants of Health & Disaster Recovery Physical Rebuilding Restoration of Livelihoods Shelter The Role of the Nurse References Appendix I: AT-A-GLANCE: Capability Definitions, Functions, and Associated Performance Measures Capability 1: Community Preparedness Capability 2: Community Recovery Capability 3: Emergency Operations Coordination Capability 4: Emergency Public Information and Warning Capability 5: Fatality Management Capability 6: Information Sharing Capability 7: Mass Care Capability 8: Medical Countermeasure Dispensing Capability 9: Medical Material Management and Distribution Capability 10: Medical Surge Capability 11: Nonpharmaceutical Interventions Capability 12: Public Health Laboratory Testing Capability 13: Public Health Surveillance and Epidemiological Investigation Capability 14: Responder Safety and Health Capability 15: Volunteer Management Appendix II: Sequence for Putting on Personal Protective Equipment Centers for Disease Control and Prevention Sequence for Putting on Personal Protective Equipment (PPE) Use Safe Work Practices to Protect Yourself and Limit the Spread of Contamination How to Safely Remove PPE Example 1 Perform Hand Hygiene Between Steps If Hands Become Contaminated and Immediately After Removing All PPE How to Safely Remove PPE Example 2 Perform Hand Hygiene Between Steps If Hands Become Contaminated and Immediately After Removing All PPE Appendix III: Glossary of Terms Commonly Used in Disaster Preparedness and Response Appendix IV: Creating a Personal Disaster Plan Emergency Planning for People With Special Needs Disaster Supply Kits Water: The Absolute Necessity Food: Preparing an Emergency Supply First-Aid Supplies Tools and Emergency Supplies Clothes and Bedding Specialty Items Appendix V: CDC’s Public Health Emergency Preparedness Program: Every Response is Local Appendix VI: Radiation Infographics Index What a wonderful resource!"--Doody's Medical Reviews The 4th Edition is unique in recognizing the rapid changes in both the causes of crises and the latest attempts to provide timely multidisciplinary approaches to the practice of this growing specialtyEvident throughout this edition is the call to identify crisis leadership among the increasingly talented base of nurses who have responsibility to move the profession to recognize and accept that they can be advocates for better planning, coordination, education and training. - Frederick M. Burkle, Jr., MD, MPH, DTM, PhD(Hon.), FAAP, FACEP Senior Fellow & Scientist, Harvard Humanitarian Initiative, Harvard University & T.C. Chan School of Public Health From the Foreword This impressive edition builds upon the solid foundation of the first three award-winning editions with an expanded focus on climate change related disasters, globalization and its implications for emerging and re-emerging infectious diseases, the accommodation of high-risk, high-vulnerability populations, and the potential for disaster arising from a world witnessing increasing community violence and civil unrest. -Patricia M. Davidson, PhD, MED, RN, FAAN Professor & Dean, Johns Hopkins School of Nursing From the Foreword The contributing authors read like a Whos Who of disaster leaders. They lend their special expertise and insights, which are supported and elucidated by cogent learning strategies in the use of case studies, student questions, and packed content in all areas of disaster participation, preparedness, policies, and research. For over 16 years [this book] has been the hallmark text in its field and this edition proves to be the best ever. -Loretta C. Ford, RN, PNP, EdD Dean Emeritus, University of Rochester School of Nursing Founder of the National Nurse Practitioner Program Member, National Womens Hall of Fame Featuring the most current, valid, and reliable evidence-based content available, this three-time AJN winner once again presents an unparalleled resource for disaster and emergency preparedness. Disasters lay heavy burdens upon healthcare systems that stretch all levels of society. While natural and man-made disasters are not new, the global nature, rate, type, and totality of their impact has only increased. The fourth edition of this foundational text uniquely addresses the rapid changes in these crises and analyzes the latest attempts to provide timely, multidisciplinary healthcare. Nurses consistently comprise seventy or more percent of responders to local, national, regional, and global crises, and represent a potentially untapped resource to achieve surge capacity goals and optimize population health outcomes. Considering recent world events and increasing geopolitical tensions, Disaster Nursing and Emergency Preparedness, Fourth Edition now features expanded content on the ubiquitous threat of terrorism, potential detonation of thermonuclear weapons, emerging and reemerging infectious diseases, and increasing frequency and intensity of natural disasters from climate change. This text promotes competency-based expert nursing care during disasters and positive health outcomes for small and large populations consistent with the Federal Disaster Response Framework. Whenever possible, content is mapped to published core competencies for preparing health professions students for response to terrorism, disaster events, and public health emergencies. The fourth edition retains the clearly organized format in each chapter that includes an overview, learning objectives, a summary, and case study with reflective questions. New to the Fourth Addresses the most recent landmark agreements Sendai Framework for Disaster Risk Reduction 20152030, the United Nations Sustainable Development Goals, and the Paris Climate Agreement Covers public health emergencies inv What a wonderful resource!" --Doody's Medical Reviews The 4th Edition is unique in recognizing the rapid changes in both the causes of crises and the latest attempts to provide timely multidisciplinary approaches to the practice of this growing specialtyEvident throughout this edition is the call to identify crisis leadership among the increasingly talented base of nurses who have responsibility to move the profession to recognize and accept that they can be advocates for better planning, coordination, education and training. - Frederick M. Burkle, Jr., MD, MPH, DTM, PhD(Hon.), FAAP, FACEP Senior Fellow & Scientist, Harvard Humanitarian Initiative, Harvard University & T.C. Chan School of Public Health From the Foreword This impressive edition builds upon the solid foundation of the first three award-winning editions with an expanded focus on climate change related disasters, globalization and its implications for emerging and re-emerging infectious diseases, the accommodation of high-risk, high-vulnerability populations, and the potential for disaster arising from a world witnessing increasing community violence and civil unrest. -Patricia M. Davidson, PhD, MED, RN, FAAN Professor & Dean, Johns Hopkins School of Nursing From the Foreword The contributing authors read like a Whos Who of disaster leaders. They lend their special expertise and insights, which are supported and elucidated by cogent learning strategies in the use of case studies, student questions, and packed content in all areas of disaster participation, preparedness, policies, and research. For over 16 years [this book] has been the hallmark text in its field and this edition proves to be the best ever. -Loretta C. Ford, RN, PNP, EdD Dean Emeritus, University of Rochester School of Nursing Founder of the National Nurse Practitioner Program Member, National Womens Hall of Fame Featuring the most current, valid, and reliable evidence-based content available, this three-time AJN winner once again presents an unparalleled resource for disaster and emergency preparedness. Disasters lay heavy burdens upon healthcare systems that stretch all levels of society. While natural and man-made disasters are not new, the global nature, rate, type, and totality of their impact has only increased. The fourth edition of this foundational text uniquely addresses the rapid changes in these crises and analyzes the latest attempts to provide timely, multidisciplinary healthcare. Nurses consistently comprise seventy or more percent of responders to local, national, regional, and global crises, and represent a potentially untapped resource to achieve surge capacity goals and optimize population health outcomes. Considering recent world events and increasing geopolitical tensions, Disaster Nursing and Emergency Preparedness, Fourth Edition now features expanded content on the ubiquitous threat of terrorism, potential detonation of thermonuclear weapons, emerging and reemerging infectious diseases, and increasing frequency and intensity of natural disasters from climate change. This text promotes competency-based expert nursing care during disasters and positive health outcomes for small and large populations consistent with the Federal Disaster Response Framework. Whenever possible, content is mapped to published core competencies for preparing health professions students for response to terrorism, disaster events, and public health emergencies. The fourth edition retains the clearly organized format in each chapter that includes an overview, learning objectives, a summary, and case study with reflective questions. New to the Fourth