Community Emergency Preparedness – Episode 5 – Effect of Forest Fire on the Health of Surrounding Community

The Neighborhood in its fifth episode, the second season, reports of a wildfire whose health impacts have affected various sections of the community. The smoke from wildfires contains particulate matter that pose a great health threat since they are small enough to bypass the body’s protective mechanisms present in the throat and nose (Lee, Falter, Meyer, Mott & Gwynn, 2009). In the Neighborhood, the wildfire has remained uncontained for five days due to strong winds (Harris, n.d). Although the city officials have insisted that the forest fire is yet to pose any direct danger to the town’s residents (Harris, n.d), the health effects resulting from air pollution are evident in various sections of the community such as the school, hospital, senior center and various households.

In the hospital, the neighborhood wildfire has increased the number of patients admitted with emphysema and asthma. The increased admission has strained the resources in the emergency department; for instance, the increased admission has led to a shortage of beds thus putting a pressure on the hospital to discharge patients. The increased workload has also stressed the healthcare professionals and lowered their morale. In the school, the effects of pollution from the wildfire may be evident from Kelsey Young’s story, an asthmatic second-grade student. When the teacher sends Young to the nurse’s office since she has been coughing, the nurse observes that her respiratory rate has increased and has a wheezing in her lungs. Kelsey also informs the nurse that she has problems breathing. The effects of pollution from the wildfire are also visible in the Senior Center nursing clinic where the geriatric nurse, Karen Williams, notices that most residents such as Mr. Dallion require oxygen more often following the wildfire. For Mr. Dallion, the polluted air has resulted into a cough, one of the symptoms that is associated with exposure to smoke (CDC, 2007).

Further effects of the forest fire are observed in various households. One such house is Jimmy Bley’s; Jimmy suffers moderate emphysema and hearing loss. He is among the groups considered to be at high risk of adverse effects in the event of inhaling smoke-polluted air (CDC, 2007). Following the wildfire, Jimmy’s condition is deteriorating; he has had to use the inhaler more frequently to arrest the increasing episodes of shortness of breath. Such episodes have affected Jimmy’s daily activities greatly, but he has been unsuccessful in his attempts to stop smoking. During one of the nights, Jimmy is unable to catch his breath and his inhaler seems not to help (“Bley household”, 2009). His condition deteriorates forcing his wife and his daughter to take him to the hospital. Following initial assessments in the emergency department, Jimmy is admitted to the intensive care intubated on a ventilator where initially his condition worsens but later improves by the end of the second week of admission (“Bley Household”, 2009). Eventually, after receiving respiratory, physical and occupational therapies, Jimmy regains his ability to move and conduct activities of daily living (ADLs) and is thus discharged (“Bley Household”, 2009).  However, Jimmy has to remain attached to the oxygen and his condition necessitates him to attend outpatient sessions regularly for physical, occupational and pulmonary therapy (“Bley Household”, 2009).

With the cases resulting from the wildfire, healthcare professionals took various actions to avoid catastrophes. At the school, for instance, the nurse advises Kelsey’s mother to bring an inhaler to the nurse’s office for use in the event Kelsey needs it while at school. Although Kelsey’s mother is reluctant to heed this advice, the nurse’s precautionary action is appropriate since Kelsey has already experienced breathing problems, which may become pronounced with continued pollution from the uncontained wildfire (CDC, 2007). At the seniors’ center, the geriatric nurse also gives the right advice to residents, informing them to remain indoors to reduce exposure to particulate matter that could worsen their condition (CDC, 2007). At Bley’s household the responses of healthcare workers when Jimmy is brought into the emergency department helps save his life. They help Jimmy move from dependency on the ventilator to being able to move and perform his daily activities, only requiring weekly visits to the clinic to monitor his progress (“Bley Household”, 2009).

In the neighborhood wildfire episode, public healthcare teams play various roles to arrest fatalities that would have resulted from the emergency. For instance, the actions by the school nurse and the geriatric nurse attempt to mitigate the fatalities that may result from continued exposure to the smoke-polluted air for the vulnerable groups – the elderly and an asthmatic child (CDC, 2007).  On the contrary, the hospitals scenario evidence a lack of preparedness resulting in the incapacity of the hospital to offer appropriate response to every member requiring attention (Jakeway, LaRosa, Cary & Schoenfisch, 2008). Such a situation that could have been prevented by scanning the community to identify the vulnerable groups thus providing information to set up additional resources that would enhance the hospital’s capacity (Jakeway et al., 2008). Bley’s household demonstrate the  response and recovery roles of healthcare teams where they help save Jimmy’s life by providing appropriate care, and improving his well-being through follow-up sessions after discharge (“Bley household”, 2009).

The Neighborhood episode also portrays public health nurses to be among the first-responders during community emergencies. For instance, the school nurse and the geriatric nurse are the initial individuals to respond to the wildfire-related incidences in their areas. Since such nurses interact with specific sections of the community on a daily basis, they are in a better position to notice health changes that take place among the group of people under their care. However, monitoring the effects of community emergencies should not be left only to public health nurses. As evident from Bley household’s case where the family members are the ones who takes Jimmy to the hospital, monitoring of emergencies should also include those nurses working in various departments in the hospital. By evaluating the cases reported in the hospital that relate to an emergency, such nurses can help the hospital to build better capacity to serve a larger population in the event the situation aggravates.

The Neighborhood episode also evidence that effective response to community emergencies require a concerted effort of different public health agencies. At the national level, an example of agency that could support the response initiatives at the Neighborhood is the Centers for Disease Control and Prevention (CDC), that provides information and resources to enhance initiatives aimed at enhancing emergency preparedness and response (CDC, 2011). At the state and local levels health departments, regional and local hospitals could have enhanced the response to the emergency. For instance, in the case of the hospital, other hospitals could have lessened the pressure of discharging patients before full recovery by admitting some of the patients. For health departments, provision of more staff to attend to cases brought to the hospital would lessen the stress on existing staff.

The Neighborhood scenario portrays that public health care teams enhance citizen’s preparedness in community emergencies. This follows from their potential input in all stages of preparedness – mitigation, preparedness, response and recovery. For instance, such teams can prevent an emergency by instituting effective mitigation practices. These practices would involve assessing the level of awareness of the individuals under their care of ways to prevent fatalities in case of an emergency, preparing a teaching plan to educate such individuals on the preventative approaches and using the teaching plan to offer education sessions on preventing fatalities in emergencies (Jakeway et al., 2008). Following such sessions, the public health professions can then evaluate how effective the teaching sessions were through modeling scenarios where the participants practice the aspects embodied in the teaching plan (Jakeway et al., 2008). In terms of preparedness, healthcare teams can assess vulnerable populations to focus their planning, training and evaluation on the care for such vulnerable populations (Jakeway et al., 2008). In the aspect of response, teams are important in determining specific needs for victims, providing adequate manpower to avoid burnout of individuals on the response team, and assigning staff to areas where assistance is required (Jakeway et al., 2008). For recovery, the teams would be involved in assessing the capacity of community resources for recovery, collaboration to implement sustainable goals following the emergency, and participate in activities aimed to restore community services following the emergency (Jakeway et al., 2008).

In the Neighborhood case, public health teams could have assisted Bley’s household in various ways. Since Jimmy was already diagnosed with emphysema, public health teams at the unit could have monitored his situation more closely with the occurrence of the wildfire. With his medical history, the team would have alerted the family of Jimmy’s vulnerability thus ensure he was taken for examination once the initial signs that his condition was deteriorating appeared. Such alert would also have helped the family to monitor Jimmy and persuade him from engaging in habits such as smoking that increased his vulnerability to fatal consequences following exposure to smoke from the wildfire (CDC, 2007). Through these activities, the healthcare team might have prevented Jimmy’s condition becoming advanced to the extent of requiring oxygen even after discharge.

To increase personal preparedness for community emergencies, one needs to have information on various aspects that would better ones response. In the case of the Neighborhood, knowledge of symptoms that indicate that one is being affected by the smoke could have led to various characters responding appropriately to the emergency. For instance, Jimmy’s persistent coughing could have influenced him to seek medical assistance before his condition worsened if he were to associate it with the effect of the smoke. Similarly, knowledge of the symptoms associated with exposure to smoke, could have motivated Kelsey’s mother to send an inhaler to the school as the nurse had advised. Other information that would enhance ones preparedness is the knowledge that one is among the vulnerable population in case of an emergency. This knowledge helps one to take heightened precaution in the event that such an emergency arises.

 References

Bley household. (2009). Retrieved from http://www.pearsonneighborhood.com/lvl3/households/bley/bley,household_week01.cfm

Centers for Disease Control – CDC (2007). Health threat from wildfire smoke. Retrieved from http://www.bt.cdc.gov/disasters/wildfires/facts.asp

CDC. (2011). Emergency preparedness and response. Retrieved from http://emergency.cdc.gov/

Jakeway, C. C., LaRosa, G., Cary, A. & Schoenfisch, S. (2008). Emergency preparedness and response: A position paper of the association of state and territorial directors of nursing. Public Health Nursing, 25(4), 353-361, doi: 10.1111/j.1525-1446.2008.00716.x.

Harris, J. (n.d). Neighborhood news. The Neighborhood, season 2, Episode 5.

Lee, T., Falter, K., Meyer, P., Mott, J. & Gwynn, C. (2009). Risk factors associated with clinic visits during the 1999 forest fires near the Hoopa Valley Indian Reservation, California, USA. International Journal of Environmental Health Research, 19(5), 315-327. Doi: 10.1080/09603120802712750.

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