The Environmental health supervisor or Operations Section Chief performs County wide functional exercises in emergency preparedness and response training. This role also involves being responsible for developing and implementing strategy to ensure the objectives of the situation are being met. This role is responsible for organizing, assigning, and supervising the tactical field resources. The director of community health promotion facilitates focus groups along with reduces health disparities training. The epidemiologist, or planning section chief works on community based behavioral interventional training, and is responsible for gathering, analyzing, and disseminating information. The planning process will be managed by this role and the Incident Action Plan will be brought to the table. The health educator, or public information officer takes the role in risk communication training. They also assure the appropriate public health information is provided to the community and other agencies involved. The responsibility of making sure the public health staff is aware of the situation so the message from the agency can be consistent. Communication is key. The public health nursing supervisor performs mass dispensing sites training. The health planner or Liaison officer would serve as our Liaison officer and would be the point of contact for supporting agencies by completing briefings and answering questions. A logistics section chief will be needed and they acquire the materials needed by Operations to get the job done such as supplies and equipment. The finance/Administration section chief is responsible for ensuring that proper contractual and financial processes are in place and is essentially performing her duties as bookkeeper. The community health nurse followed the above chain of command for different assigned tasks. If a problem fell under the Liaison officer then they would be approached. The community health nurse has a multitude of resources that are available to her if situations arise that are outside of the nurse's scope of practice. The nurse can always look up to the chain of command for assistance with any question or direction on where to go to find the answer. All state and government resources such as FEMA, FDA, Red cross, Poison control center are all available resources that may be utilized. Other hospitals, state health departments, other counties, EMSA, local food banks, animal shelters, and veterinarians are more

examples of resources they can be utilized by the public health nurse. If the water is thought to be contaminated then local water treatment facilities may be contacted. The media must also be a point of contact to get the messages across to people. A vendor list with sanitation related vendors such as port a potties would be a very useful point of contact at this point due to the unsanitary nature of the effects of the storm. Some type of communications network must be set up due to the inoperable phone lines. If communication is an issue for the nurse, which it will be, then going to someone who knows more about the network would be very helpful. Contacting local gymnasiums to set up a possible temporary housing shelter would also be a necessity. Back to the vendor list about clean water. The water is contaminated so utilizing outside resources for water would also be a necessity. Gaining the access to hand sanitizer or soap would also help with the contamination issues. When the nurse encounters possible emergency situations at the door to door interviews the nurse needs to have a viable line of communication to speak to the necessary people that need to be involved. Also it would be helpful for the nurse to carry around a "Medical bag" with supplies such as dressings, tourniquets, IV starting kits, fluids, blood sugar diagnostic information with the fast 15 available, and the knowledge to know what to do and act as a triage nurse when determining what exactly is wrong with the person. The people that are going to be encountered just went through a horrible natural disaster, and are going to be in a state of panic. Communication is important, as information that you would go over normally in a "normal" community setting is going to be completely different due to the catastrophe.

Having the availability of the tetanus vaccine for injured people the nurse may come

across may be helpful in stopping contamination. It would be helpful for the resident Matt Westlund to have information on clean up after chemical spills. Also information on how and where to dispose of this material in order to keep the contamination level low. Shelter information would also come in handy in this instance because even thought no one is hurt right now it would be best for this resident to vacate the premises due to the spilled chemicals, remain in the shelter until adequate help has arrived, then go back during the day to assess and clean up the damage. Flooding can cause many problems such as mold, so knowing the right information about mold would also be very important. When the community health nurse encounters Susan Fuhr a strong line of communication is necessary, to alert other healthcare providers about this missing man. Also having someone this woman can speak to, and also someone who can relieve the stress of the mother and baby she is dealing with while also worrying about her husband. The Alvarez residence is not very familiar with English, so again having a strong line of communication is important to get someone who speaks their language their to assist to eliminate the language barrier. The community health nurse needs to have a system in place for follow up post disaster to ensure that the community is gaining and maintaining the old normalcy. If there are instances of PTSD then the nurse can set up post interviews, along with the assistance of an LPC or licensed professional counselor. Techniques that could have been used to calm the fears of the people interviewed could have been as simple as having hand outs that are a standard on the entire emergency services that may be needed. A list of the local shelters, local animal shelters, transportation services, food services, water services, disposal of waste, etc. Just having the information at hand and having a contact is reassuring for most people. Knowing that if they need something they have the means to get to it, or have the information on how to get it. For example, the environmental health specialist could have a hand out made for the clean up of household or hazardous material. There were inspections that were performed post disaster to inspect restaurants to ensure the safety of the conditions where the food was being prepared. The community health nurse also needs to assess the needs of the people once it is safe for them to return to their own homes. The people are ready to get back home, but the community needs to make sure the homes are safe and ready for the residents. Food supply needs to be looked at to help the residents ensure there is enough food to provide. The information fair that the town is holding is going to be a good thing for the residents that have questions, a time to get them answered if there are any left unanswered. Nursing personnel could be prepared to help in responding to similar situations for a much larger affected area such as with hurricane Katrina to just have a disaster plan in place with all of the information needed with all of the possible situations that they may encounter. A book of policies and procedures. Most hospitals have this in place, along with most local communities that are used to having disasters. If a plan is set in place with people who know what part they are supposed to play then this is more likely to happen. Being linked in to other outside resources would be helpful as well. There is a website called National Nurse Emergency Preparedness Initiative that goes over current or emerging threats. This helps the nurse be prepared on a national level on what is recommended. Therefore, if you are a nurse in a rural community and a disaster happens you are up to date on all current practices. Staying informed is important. Drills must be one, so the actions are being enforced. This will ensure that they are remembered better. Teamwork and communication are essential during emergency response states Gebbie and Qureschi, 2002. This is a task that must be practiced.

References
National nurse emergency preparedness initiative . (2005). Retrieved from http://www.nnepi.org/

The role of public health nurses in emergency preparedness. (2007, October 29). Retrieved from http://www.astdn.org/downloadablefiles/ASTDN EP Paper final 10 29 07.pdf