Mobilizing the community to Prepare for Disasters: One Nurses Journey (March 2022)

good afternoon my name is Charles Jennings I'm director of the Christian reaghard Center for emergency response studies here at John J College of Criminal Justice and uh I'd like to welcome you to the uh March event in our Christian reaghard Center uh seminar series uh for those of you who were not familiar with the center we a first responder applied policy Research Center um and if you'd like to find out more about our events we have several ways to stay in touch uh you can join our list serve uh which is becoming kind of quaint in this day but uh we still use it and uh by clicking on contact on our web page which is Christian reaghard center.org we also have an active Twitter feed at Racers JJC and we book all of our events through uh Eventbrite uh and so for today we're very pleased to have a session featuring one of our uh collaborating uh faculty members um Dr uh Tara Hegel uh who was with the uh Hunter College uh Belleview School of Nursing here at uh cuni and uh she uh is a serves in leadership roles in her professional nursing associations uh she's a nurse in case you didn't pick up on that she enjoys monitoring healthc care Trends writing letters and making making phone calls to legislators and being an advocate for nursing uh she started her program of re research exploring household emergency preparedness of elderly and medically frail community members qualitatively with the scope of with the hope of better understanding the reasons why people do or do not prepare for disaster in order to inform policy uh and she's particularly interested in the role that nurses can have in mobilizing the community to prepare for and recover from disasters um and for anyone who stud Emergency Management um or anyone who's just been watching the headlines in our latest uh the covid Health crisis um this is an area that is becoming increasingly recognized as Central to uh preparing communities and and building resilience uh to a a natural disaster generally and as well as public health emergencies so with that I want to turn it over to uh Tara and uh welcome you uh to the uh seminar we've been having you uh on the the Affiliated faculty for several years and we're delighted to finally get you on board uh doing a talk and uh and and so take it away it's all yours thank you thank you for having me um I'm GNA stop sharing your screen we'll go to mine okay well thank you um uh for having me for all of you joining me um you know before we get started I'm going to ask you to do an easy calculation at some point shortly uh you may need a pen and paper for this I hope you don't have enough fingers to do this addition but it is potentially um that you do so here's my objectives we want to discuss the causes of vulnerability to injuries illnesses death and disability of the elderly medically frail and disasters I definitely want to discuss the role of nurses in mitigating these vulnerabilities for those you are not nurses you'll understand how you can better utilize Us in before a disaster hits instead of just during response and Recovery phase learn how to use this emergency household emergency preparedness instrument to measure level of preparedness and learn how to implement a household emergency preparedness intervention so that we can improve preparedness of households um I also hope that you will be better able to protect yourself your family and your home after this presentation and I hope that you serve as a trusted risk Communicator about the importance of disaster preparedness to your community members so let me give you a little bit of background about myself um I'm not sure if this is if there's a lot of Emergency Management folks on this um this call today but I have to establish street cred because why am I a nurse talking about Emergency Management um my research walks the line of Emergency Management public health and nursing um but where where it all started though the the Dr Hegel disaster nurse researcher origin story was that I've lived through several extreme natural weather events as a child um my most memorable was the nor Easter of 92 not sure if you guys remember that one uh I was in fifth grade actually just moved a couple of blocks away from my original childhood home to a Riverfront house literally like two or three days before that storm hit um and when the storm did hit the entire Street flooded um a house burned down like two houses away from my new house I was crying I said I want to go back to our old house it was it was a mess um so that started it also my parents frequently I would say once once a year we would spend a week down to Virginia Beach during the summer to vacation we did a couple of hurricanes down in Virginia Beach I saw houses knocked off their stilts I was in one of those houses not knocked off the stilts but the house was swaying around um they weren't doing mandatory evacuations at that time so I do recall that and at 14 years old I joined my local ambulance Squad as a junior volunteer and then I became an EMT at the age of 16 and then if you look at the picture that says Trent New Jersey 2005 I put myself through nursing school while working full-time for the city of Trenton EMS um and so that was one of the flooding events that we had around here um so I've witnessed life for threatening events because of medically frail community members not being prepared for disasters um I just going back to my EMT days two events were especially memorable um I remember there was a severe thunderstorm that caused power outages to most of the city where I grew up and uh on this one particular night there was a patient who had renal failure they were doing a home dialysis treatment and it stopped right in the middle of this power outage there was no backup generator there's no battery backup um so this person had to get transported to the hospital um during the severe thunderstorm itself there's a tree down on the street uh it was quite frightening you know remember I was a teenager back then that that was in my home City before I went into TR Ms and I do remember another time that a thunderstorm knocked out power to an entire nursing home their backup generators did not click on nobody knew how to troubleshoot those generators um actually the staff didn't even know where they were so we had to evacuate um all of these patients in pitch dark with just flashlights carrying oxygen tanks carrying them down the stairs um so I I was just appalled that that could happen uh September 11th that occurred when I was 19 years old I was in college um I was a volunteer EMT on campus at that time as well it was a boys club I was the only female volunteer at EMT I was the only nursing student I didn't quite fit in so the guy all deployed to Giant stadium and left me alone on campus to handle Ems for all of these other frightened college students so that stuck out my mind then Hurricane Katrina in 2005 hit I had just graduated from nursing school two months prior no three months prior and I was watching what the healthare workers were going through down in New Orleans um you know the the being stuck in the hospitals um the stadium the alleged Youth and ages that took place it was just absolutely horrified thinking to myself I never ever want to be in that situation I don't want anyone else to be in that situation um and something's got to be done about this so um let's go to 2012 hurricane stand you can see that picture in the bottom corner that's my um childhood home my parents still live there it was completely flooded um the whole ground floor had to be gutted during Sandy I should say short shortly after Sandy so I worked as a critical care transport nurse you see that with the satu so I've been in the ambulance um you know those nurses that fly in helicopters with their cool jumpsuits uh I did not do that but I did their exact same job without a jumpsuit but in an ambulance so my transports were often quite quite long and then you'll see 2020 working during covid 2021 I've deployed um with my local Medical Reserve Reserve core to administer covid vaccinations to community members did that several times so I've worked both as an EMT and a nurse in New Jersey since roughly 1999 I've either volunteered or worked through every local disaster during that time and I shouldered the burden of unprepared community members during disasters I and my co-workers and if I'm being completely honest with you guys my husband's a career firefighter so him as well we've all put ourselves at risk when rescu people during dangerous storm um conditions so my research Journey which is still you know kind of in its infancy stage I'm only four years into Academia um it started from an area of frustration so why why are these people in my ambulance why are these people in my ER why weren't they prepared why you know why is it pref preferable to spend this time in the hospital or should you be on your couch under a blanket with your flashlight and your cat um and I'm happy to report that very very very quickly into my research Journey that that frustration transitioned into understanding there are so many reasons why people cannot prepare for a disaster um and now it's my role to help the our community members get prepared and by presenting this you know kind of my research Journey thus far to you I hope to inspire you to start doing some disaster research as well so I want to talk about some pictures of throughout my presentation they feature my home disaster preparedness kit and also the commercial disaster kit that I have chosen to use for my intervention studies I put the contents of these kits in the captions under the pictures I'm not going to talk about them just kind of there for your viewing pleasure I have to say though I have no commercial interest in in these um I'm not sponsored by them I'm not officially endorsing these products in fact all I do is give them my money I'm not getting paid for any of any um anything related to the disaster kits it's just I'm just showing you what I have used in my own personal life and um that's it for those so here here's my disaster kit if you saw um look at this slide before it's in one tote um and the and the um water case of water sits on top of it all of that stuff on that table there fits in that one container and I can grab that container in a precipitous evacuation I also have a go bag in my car that has clothing and toiletries that stays in my car all the time this one lives in my house though so that brings us to our first poll before we learn how we can help uh community members get prepared for disasters let's do a case study about preparedness using you as the case so let's go ahead and see if you can vote I see at least one person has one more person okay this person must be doing something else so can you see the results here it looks like 50% of this crowd does have a home survival kit and 50% does not so let's think on that actually let's reflect first half of this crowd which um you know you guys might might or most likely are Emergency Management folks um half of you have a survival kit and half of you don't so how do we expect our community members who don't have the knowledge that we do or the means that we do to prepare themselves for disasters so here is a household Mery preparedness questionnaire that I developed with an amazing team I'm going to talk more about this later on the presentation but to continue our case study using you as the case I want you to go ahead and give yourself one point for every yes keep track of your points um we do have a few slides of these so have you prepared and discussed a family emergency plan the answer is yes one point Have You practiced or drilled on what to do in an emergency at home have you taken first aid training do you have working smoke detectors do you have a fire escape plan for your home do you know the types of disaster that are most likely to occur in your community do you have important family documents such as copies of your insurance policies identification and bank account records in a waterproof portable container or stored on a flash drive or cloud storage server have you signed up for a community emergency alert system do you have supplies set aside in your home in a kit to use in case of a disaster and do you have Supply or do you check your disaster supplies regularly for expired items and if you have the shut up shut off valves in your home do you know how to turn off the utilities your water your gas your propane so yes gets one point NOS or zero next one again yes is on this slide get one point NOS or zero have you planned for how you and your family would contact each other in emergency if you were separated and do you have a written contact information of family and friends and if there's no power or telephones would you have a way to receive information about disasters in your area such as with a solar hand crake or battery operated radio so you'll tally up your scores for slides one and two add them together and moving on to evacuation plans again you get one point for every yes in the event of evacuation have you considered safe and unsafe places in your community do you know if your home is in an evacuation Zone have you planned where to go if you had to evacuate from your home um do you do you have a source of transportation to leave your neighborhood quickly in the event of a necessary evacuation do you have family meeting place in case of a separation is everyone in your home aware of that evacuation plan do you have family and friends that you could stay with during an emergency do you know where your local emergency shelter is do you have a plan for what you'll take if you had to leave your home quickly and have you prepared a small kit with emergency supplies to take with you if you had to leave quickly if you have a pet and you guys can probably hear mine now because they're barking if you have a pet do you have an evacuation plan for your pet and then here's our last slide again these are yes or no questions give yourself one point for every yes so they're asking about do you have a supply one gallon of water for at least each person in your home for at least a week one gallon per day per person for one week do you have a onewe supply ready to eat food do you have moist toets hand sanitizer other kind of personal hygiene supplies do you have a flashlight a torch a headlamp lantern glow sticks candles other non-electric portable lighting do you have a first aid kit do you have a sleeping bag or warm blanket for each person do you have cash do you have extra batteries matches a fire extinguisher do you have wrench pliers or a multi-tool that will be able to turn off your utilities and if you wear prescription glasses or contacts do you have extra glasses or contacts if you have a baby do you have a one week supply of formula bottles and baby food do you have a onee supply of diapers or nappies and do you have a onee supply of pet food and water for each pet and if your pet takes medications do you have a twoe supply of medications so um tally up all of your points now I realized some of these questions are not applicable to you um in the in the actual instrument there's we get we tell you how to handle that but tally up your points and we should have 41 points if all of these questions were applicable to be considered prepared for a disaster however some since some of them are not applicable um and you know you could be mostly prepared now run to the grocery store grab what you're missing and then be completely prepared in 30 minutes so I'm going to be nice and say that if you have 31 items or more then I'll consider you prepared for a disaster so let me activate the next poll okay what was your happy score all right one more person they might not be floating around so we've got there you go 67% of our our people here on this call are unprepared 33% are and that's actually better than normal honestly that's you guys are doing pretty good so again like I said doing some self-reflection for this case study we presumably have good jobs we're fairly able-bodied um and yet still we're not completely prepared for disasters how can we expect elderly and medically frail community members to prepare so let me give you a little background you probably know about this stuff so it'll be quick um there's a growing frequency of extreme weather events and man-made disasters and humanitarian crises the greater part of the population under study vulnerable or not no matter the G the demographic characteristics or the geographic location is unprepared for disaster that's been shown in numerous studies it's rare that you'll see an assessment study that demonstrates prepared population um also in the literature there no there doesn't seem to be a single accepted definition of what exactly it means to be prepared and there's no gold standard instrument out there yet I hope mine will be the gold standard so household emergency preparedness it's a public health concern lack of preparedness especially in medically frail populations consumes responders time and it can easily deplete Community Health Resources so increased levels of of household emergency preparedness could plaus POS save lives prevent worsening of chronic medical conditions and decrease the likelihood of responders having to breath dangerous situations to assist those in need um however literature is actually lacking to support those claims we we haven't done um as a disaster research Community an experimental study looking at if you are prepared for a disaster are you more likely to survive are you less likely to need assistance are you less likely to have an exacerbation of your chronic medical condition are you less likely to get injured or sick um so those those types of studies are greatly needed the disasters are always inclusive response and Recovery are not unless we plan for it great quote from the female Emergency Management Institute Disability Policy consultant um so community members with access and functional needs have special needs that should be accounted for during disaster preparedness response and recovery what does that mean um these are the folks that have this is what United States FEMA describes as having access and functional needs in disasters um folks that are elderly that's anyone greater than 65 years of age and people who are medically frail so people with serious and complex medical conditions and those with physical and or mental disabilities that significantly impair their ability to perform one or more activities of daily living uh elderly people are often frequently medically frail the scope of the PO problem is you know the entire population is aging right and then we've got Medical Services increasingly being administered in the community so this data is from a few years ago uh I think after this pandemic we're we're putting even more Healthcare in the community so a few years ago 54.5 million medically fril community members lived in the community not like in a nursing home or rehab 47.5 million people had disabilities and could possibly not be able to take protective measures during a disaster and 133 million people with a chronic illness um that could be exacerbated by disaster conditions and those conditions are loss of power temperature extremes um you know loss of access to their providers all of that kind of stuff then we've got more people developing and living in coastal areas uh in on our area in the East Coast of United States our hurricane frequency has increased by 40% and worldwide there's a growing frequency of extreme weather events man-made disasters and humanitarian crises so the summary of this morbidity mortality outcomes for the elderly and the medically frail are disproportionate to the rest of the population and not addressing these vulnerabilities has been shown to have negative effects on both the response and the community as a whole that's because they're less likely to recover economically from the expenses related to disasters uh they make it makes an already vulnerable population impoverished and then medical needs of the elderly and medically fail exacerbated by that disaster become a severe strain on already stretched disaster resources so it's important for nurses and of course everyone else on this Zoom call to understand what makes individuals vulnerable during disaster in order to address those vulnerabilities um during the preparedness phase of emergency planning got to stop being reactive we'll be proactive so you guys can participate and nurses as well in all aspects of disaster preparedness mitigation response and recovery and that brings me to my first research study my dissertation study actually the purpose of it was to understand how older and medically fril adults have experienced disaster and how this experience impacts what they do now to prepare for disaster and I wanted to generate Theory regarding the process through which community members prepared for disasters it was actually a qualitative study it had to be because I could not find uh an instrument a household preparedness instrument to use so I can share the publication that I've cited it goes into much more detail on the community level Emergency Management interventions along with all of the evoc evocative qualitative data from my participants um the presentation this this particular presentation today is focused on barriers and facilitators of individual and household level preparedness um so spoil alert though the only participants in my study that I found to be prepared for disaster had attended this class at the local Senior Center called storm it's called seniors taking on Readiness measures and it was actually offered by Emergency Management Personnel they um these guys would go to the senior center they'd have a class on had to prepare for disaster they had homework to do they did their homework they got a free disaster Supply kit and then they went on their way and these were the only participants that were actually prepared for a disaster in my study let me see if I forget anything oh this is what I wanted to tell you um with the volume of data that I analyzed for this study I was able to get a few Publications out of my dissertation so they are all cited on various slides if you want more information on different aspects you'll know where to look so here's my data sources I had 31 knowing participants so those were um community members elderly medically frail community members that survived hurricane Sandy this this study took place in the city of Long Branch New Jersey where I grew up um and these were Sandy survivors so my saturation remember it's a qualitative study we look for saturation right saturation of disaster experience motivation preparedness actions and Community interventions ended at 26 but I wanted more information on preferred information sources so I kept um I kept interviewing I took memos I took field notes I included a ton of P reviewed research and journal articles I've read Emergency Management textbooks newspaper articles I analyzed 143 newspaper articles um Irene in 2011 Sandy in 2012 waten in 2015 Matthew in 2016 herine in 2016 and I also looked at a winter storm Stella in 2017 um and so I I Incorporated all the data that I was seeing uh distributed in these newspaper articles into my analysis um and then I had I was watching televis BR television broadcasts during disasters to see what was um discussed about disaster preparedness and documentaries as well and the purpose of collecting the non-interview data was to perform discourse analysis on what is disseminated about natural disasters with a focus on household emergency preparedness recommendations and the discourse was that people should take responsibility for their own preparedness we should not be relying on the government here's some more data sources that I had um I looked at all the household emergency preparedness educational resources that are are offered like FEMA Red Cross um CDC all of that stuff they internet postings their brochures their pamphlets their posters their swag I looked at reports from senior ad ADV groups like help age International um ARP I was looking to see what they did talked about emergency preparedness I even attend emergency preparedness conferences so if any of you guys get the chance to come to New Jersey our New Jersey um EPA conference in Atlantic City's a good time great conference so I attended two of those I went to a community Festival huge Community festival with a very heavy Emergency Management presence there was Emergency Management folks every few stands wanted to see if they would discuss anything about disas and disaster preparedness um because there was other community organizations there that were handing out you know what their organization did and stuff like that I didn't see any there though and then I also looked at books coffee table books of storms non-fiction books Memoirs of Sandy survivors and I even found a cookbook which there I have a picture of later on a cookbook for disaster cooking pretty much when you don't have a heat Source or a water source what do you do with all of your non- perishable Goods I've reviewed the these Emergency Management plans I looked at public policies at the state and federal level I looked at flood maps and then I interviewed in addition to the Sandy survivors I interviewed the emergency manager of the city and a home health care nurse and summary of my findings this is so I mean this is years of work here and I'm putting it on one slide summary of sign findings is that the coastal Urban elderly medically fril community members are generally considered unprepared for disaster according to Fem FEMA standards and that's due in large part to to a lack of education on how best to prepare once they're educated I saw motivation for self- responsibility of household Mary preparedness you can expect that and then Community interventions like Distributing disaster Supply kits and offering evacuation system assistance help overcome their situational impediments to preparedness and it helps them it provides the best chance for these vulnerable community members to survive disasters and I found to if their in dentally prepared like they don't have an official disaster kit in their house they've got disaster kit items you know kind of willy-nilly all over the place if that happens it was largely in part to their past experience with disasters or their professional experience um for example I had a few um folks that were retired either teachers or um you know um like a janitor from a school and they had set up storm shelters in the schools in previous disasters they knew what they should have in their home from their profession experience and here is where here's the findings of the vulnerability to hazards blue font the blue font here is the physical Pathways to health vulnerabilities and the purple font is the social Pathways or are the social Pathways so one is Advanced age why people are more likely to get sick injured or die during disaster with Advanced age are less tolerant of the temperature extremes due to circulatory problems L they have a loss of sub continuous tissue and sweat glands um they have reduced ability to perceive heat delayed thirst and perspiration mechanisms and they take medications that influence their temperature regulation The Chronic illnesses that are associated with um disaster morbidity immortality it's diabetes um anyone that's had a stroke a heart attack any of the chronic lung conditions like COPD empyema asthma anyone with hereditary blood disorders like Sickle Cell anyone who has endstage renal disease um high blood pressure arthritis and dementia it's because they they experienced disruptions in their routine Medical Care and they have difficulty with gaining access to their care providers and their care facilities um three is dependence on others or objects so anyone who needs assistance with activities of daily living like bathing dressing grooming using the toilet cooking their meals getting to medical care if they're relying on electricity for medical devices if they're relying on supplemental oxygen or Refrigeration for medications like insulin for patients with diabetes all of that leads to increased morbidity and mortality four is mobility deficits um this we think about Mobility deficits Mo mostly when it comes to evacuation it's difficult for these folks to evacuate quickly or even take cover and if you help them to evacuate and you make them leave their Mobility device behind like their wheelchair their Walker or the wherever you bring them to they're going to be much less self-sufficient so you've got to evacuate them with their their devices um for five cognitive de deficits anyone memory disorders dementia um Delayed Reaction times and psychological distress more likely to um get sick or injured or die during a disaster for six anyone with sensory deficits if you have an inability to see hear taste or smell um you're unable to see warning signs you don't see the the sky dark the smoke coming through you can't hear emergency instructions or alerts you have trouble navigating in unfamiliar environments and actually these folks are more likely to eat spoiled food and get food poisoning after the disaster of course lack of social support so if you have adequate social support then your family your friends the community in general they will assist you in obtaining disaster information evacuating Sheltering um feeding you getting you healthare and rebuilding in disaster situations but folks that are housebound or socially isolated individuals they're less likely to receive any of that and they may actually even be invisible to disaster responders low socio economic status if you are um you know elderly retired or if you're on disability you're on very fixed incomes and you have poor credit worthiness there's little room to afford disaster supplies fuel food lodging related to evacuation ation uh making protective Home Improvements or rebuilding post disaster um in high-risk geographical locations uh those can be uh places that are isolated or places that are Urban flood prone if they contain poorly developed physical infrastructure or crumbling infrastructure they have a high concentration of poverty limited access to Social Services um all of that uh is considered high risk for disasters um and in fact our region in the Northeast Mid-Atlantic is considered a highest geographical location it's highly populated heavily dependent on TR public transportation Public Utilities um it's also considered the economic center of the world so any kind of disaster happens in our area has wide range effects um for the country and even the world economy so we're actually a target for deliberate disasters in addition to being um at risk for hurricanes and blizzards and all of that good stuff stuff for 10 and 11 Low education level native speaking ability both of those result in a difficulty or inability um to access quality information resources so they're going to have difficulty um gaining disaster education and understanding it if they do have it um for 12 female gender uh you know women we just tend to live longer so therefore we're more likely to live in poverty and inadequate housing also if there's cultural prohibition older women may also be less likely to evacuate to shelters that do not separate individuals by gender then the shelter conditions themselves right I hear that quite a bit um if you saw what happened Katrina who who wants to go to a shelter that's not a motivation for anyone they but many lack ramps railings Health Services medications medical equipment they have inaccessible toilets there's inadequate lighting poor bedding how do we have a 90-year-old um riddled with arthritis laying on a c at ground level right there could be inappropriate food it could be excessively noisy it promotes separation from Family Support so most folks would rather stay home and instead of endure these shelter um conditions and speaking of that home old that's number 14 older folks tend to live in older homes of low structural quality with no means to make storm resilient um improvements in the past experience of disaster if they've if they've survived previous disasters with minimal negative impacts they may underestimate um the severity of future disasters and not take actions to prepare so here's our facilitators of household Ms preparedness they have to understand that a risk exists they have to perceive they feel that they're highly vulnerable to that risk but also that they can do something about it as long as whatever they have to do about their decreasing their risk is low cost and um we did see I saw caregiving responsibilities for children and family members and pets is a facilitator to household emergency preparedness uh also communication INF infrastructure is a facilitator so we need um communication infrastructure that that delivers clear concise timely and accurate messages about the threat and appropriate responses in a manner that people of all ages and literacy levels and native language speaking abilities can receive that message it's got to come through for and informal um means such as inter interpersonal Communications I'm calling at my friends and family saying hey did you get that extra case of water you go through social media Community organizations local media and other residents and it has to come through a trusted source that will facilitate coordination cooperation and adherence to recommendations and directives and health care providers in All Care settings need to educate patients and their families and household Mery preparedness and consequences of lack of preparedness um especially nurses we are the number one most trusted profession if we discuss with our patients the importance of preparedness they're more likely to understand and listen to us and in fact I just started using um uh that healthc care provider healthc care provider education as a predictor variable for preparedness and the um first three studies that we've used that predictor on there is a strong association between the provider providing them um disaster preparedness education and them actually being prepared for disaster just kind of more on effective risk communication uh throughout and this has to happen throughout all stages of the disaster it's got to be unambiguous concise and redundant messages redundant meaning that if I turn on the TV or I listen to the radio or open up a newspaper everyone is saying to do the same things you shouldn't be looking at different um news channels and different news channels are telling you to do different things because then people stop trusting uh we want to look at print television radio internet and social religious networks you want to take into account um potential visual auditory and cognitive impairments so use large font and non-glare paper and then auditory alert sounds should be broadcast at frequencies that older adults with hearing loss can perceive them who want to educate them please that remember I said um in my first initial findings lack of educ ation was pretty much the the biggest barrier to people being prepared so we can start in school um I know in New York City they have the ready girl campaign so they they're teaching disaster preparedness in the school I hope to someday evaluate the effectiveness of this I haven't seen an article doing that yet so that's on my to-do list um animal networks remember I said that caregiving responsibilities for Animals helped is a facilitator preparedness so let's distribute disaster preparedness information um through Pet Service associations veterinary offices rabies clinics any of those places would be great the water and um power companies can distribute this information and um checking on elderly neighbors everyone that that should foster social support that should be kind of a message that all media repeats over and over again you can also educate with these free resources um here's um two examples one's from New York City and then the one on the right is from New Jersey these resources can be downloaded for free off of the internet and they are offered in multiple multiple information um sorry in multiple languages so when you open up the booklet it tells you all of the phone numbers for um the utility companies it tells you where the storm shelters are how do you know if you're in a flood zone and then also has components where the person reading it has to input their own disaster plan so there's going to be parts that says um if you have to evacuate where are you going and they'll write down you know where their evacuation site is what's the root to it what are their Health Insurance homeowners insurance car insurance policy numbers and the phone numbers to reach those folks um their medical history all of that stuff is in there so they have there's a component to this where they have to fill out their own disaster plan um and I've been using these in my disaster research because if it's free it's for me so I will use it and you guys can as well just type this um the titles of these into Google it take you to the download page you can also email me at the end of the presentation and I'll reply with a copy uh here's a FEMA checklist off of ready.gov this one comes I want to say in 32 different languages there's a ton of languages this is just a supply list it doesn't have the evacuation communication plans in there but it's a one page something that could be hung up on a bulletin board or handed out so you could use that um and then uh we want to offer evacuation assistance so of course you want to evacuate folks in advance take their assisted devices with them provide them Transportation um in the study site where I did my dissertation um anyone could get on the bus and get transported from their house to the um storm shelter in the city so that and that was completely free so that should be offered you have to provide a host site and of course Evacuate the pets with the person um you know in Hurricane Sandy they the pets weren't allowed in a lot of shelters but separating an owner from his or her pet produces the same or at least it can produce the same grief reaction as the death of a family member and so evacuation of pets has to be considered if pets are not evacuated owners will most likely risk their lives by either not evacuating at all or then they're going to return too soon to the disaster Zone to find their pets so evacuate those pets um let's talk about medical need shelters those should be made mandatory and opened prior to the disasters I say that because during the Sandy situation um many of the medical need shelters were opened in the days after Sandy hits they're kind of opened too late and they were opened in areas um that were inconvenient for people to get to so we need medical need shelters they've got to be staffed with nurses Public Health Department Personnel patient um care technicians now you have your shelter staff in there you can use paramedics and EMTs and respiratory therapists mental health staff for sure and pharmacists we should have all of those folks in the medical need shelters and those for those of you that don't know it's it's a swarmm shelter but but it's for people that need you know Extra Care um more care than the average Community member so maybe they've got um like a g- tube in their stomach or they're they just got surgery last week and they're healing from that or maybe they're using a CPAP to breathe at night stuff like that those folks go to the medical need shelter and then we want to stock pile um most medications needs post disaster are actually for chronic conditions so you want to stockpile The Chronic medications um you know we want to form Partnerships with medication manufacturers medication distribution agents and Retail pharmacies to ensure that these medication needs will be met during the disaster um for implications for practice for post disaster we want an equitable distribution of supplies so meals that are distributed to non-responders should be actually heart healthy and low sodium the meals ready to eat are not appropriate for people with chronic illnesses way too much sugar way too much sodium um and then when Distributing these meals or any disaster relief suppli the elderly and the medically frail may not be able to tolerate standing in long lines and so they need to have a FastTrack Quee that should be designated just for them we want to offer psychological care the stress of disaster event could um elevate blood pressure could cause confusion alter blood glucose control and that exacerbates chronic illnesses so we want to have our psycho psychosocial interventions such as grief counseling planned for and made available before the disaster hits and of course you want to Aid individuals in obtaining governmental assistance especially because most of the governmental assistance applications are now online um and some of our community members especially the elderly are not going to be able to navigate that so help them out so I just spent a lot of time talking about how the elderly medically frail are so vulnerable but they are also Assets in disaster I definitely saw that with my participants many of my guys actually volunteered their time um in the the supply distribution centers they handed out meals and supplies they helped with community cleanup um they should not be viewed just as helpless and vulnerable they can be your trusted risk communicators they have advice and experience from past disasters they can instill hope in the younger Generations you know we've lived through this before we've rebuilt before we're going to be okay we're gonna get through this together um you know they've also been known to look after supplies the sick and injured the orphans and children other dependents while um I guess more able-bodied folks go go out and do um the demo work and the cleanup out in the community and they many have traditional survival skills so utilizing and protecting the elderly and medically failable or during an after disaster will actually enhance Community resilience overall so that was study number one and remember I had to do it qualitative because I couldn't find an instrument so that leads me to the household Mar's preparedness instrument also known as the hey the hey assesses whether specific preparedness actions have been taken and the presence or absence of essential supplies that could enable households to safely endure conditions that disasters would likely present like loss of power limitations on water lack of access to additional supplies for at least three days post disaster so accurate assessment of preparedness levels is critical for Effective planning and necessary to enhance health promotion prevent injuries and promote disaster related Community resilience this is the hey development team a group of amazing disaster nurse researchers I call us the disaster nurse researcher Rockstar so um this isn't my instrument I definitely developed it with a whole team um it's not called the Hegel emergency preparedness or um instrument it's called happy um it was a team effort and it was an international effort I'll show you guys that in a moment so here um this is my first ever article published and it was I published it while I was still a PhD student and it was part of my literature review um for my dissertation study where I did find that there was no gold standard instrument to measure preparedness it also found that there was no evidence that actually preparing for disaster does anything good at all anecdotally we know that it does um but there was not experimental studies to show that so I I typed up this opinion piece and it got published in the American Journal Public Health super proud of that so upon hire at cuni I repeated the literature review and I still found no gold standard in instrument and I knew that I needed this instrument for my program of research so the purpose of the he is to generate the I should say the purpose of the hey study was to generate a consensus on the concept definition of what exactly does it mean to be prepared for disaster we wanted to use experts representing multiple disciplines and countries along with Community stakeholders to develop this all hazards Global International valid and reliable instrument the happy questions were developed using three sources of data to inform consensus we did literature search we used existing instruments and then we did an international expert panel via ad Deli technique so literature search we found 52 articles um none of these articles were specifically instrument development Publications um When selecting an instrument for your research that's something that you need to evaluate when you're choosing your instrument um only 20 22 of those 52 articles actually had any kind of instrument development information at all whatsoever and for the researchers who created their own instruments um which was pretty much everyone the female recommendations continued to be the most popular to inspire the instrument questions then we used um existing instruments so one of our team members Dr mcneel she had developed an instrument for her work it was called the preparedness index she used it in two studies we used that as the Baseline instrument and then we added questions that we found in other people's instruments and then after the literature search and view of the evidence we agreed that a gold standard um household M prar instrument had not emerged since the article was published and then we proceeded um to do this he this instrument development via a deli study so we assembled the instrument for the deli study part participants to evaluate why why this Deli technique though it's really good if the participants don't have a history of adequate communication and if we need input for more individuals then can effectively interact in a face-to-face exchange if time and cost make frequent group meetings infeasible and if we need participant anonymity to reduce the effects of dominant individuals which is also known as the bandwagon effect so Deli studies they're they're fast they're inexpensive and they're versatile in fact I did mine um with no funding at all whatsoever um we have the ability to condense the opinions of many experts into a few precise statements people respond on their own time they don't have to show up to a meeting somewhere and the anonymity allows for participation in kind of a non-adversarial environment Deli studies are actually commonly completed with under a 100 participants and we had more than that so that was good uh we did our recruitment via email um and the compensation that we told our participants was that they were going to have free and open access to the instrument once we were done but in fact everyone has free and open access to our instrument you guys can use it in your program of research as well so we wanted disaster experts we wanted Community stakeholders we wanted um the age of consent was 21 because that is the highest age of consent worldwide it had to be English reading and we targeted the corresponding authors of the articles that we found in our literature review We targeted our interdisciplinary colleagues um the world Association of disaster and emergency medicine spread our recruitment message and we use the snowball sampling technique um our initial instrument that we assembled for them was 106 questions long we asked the participants to rank each one of those questions from one to five one was unessential like get rid of it it's a garbage question two was a little important three was neutral four was important and five was absolutely essential this will save your life and we considered consensus on a hey question if it achieved 80% of the participants votes falling within two c categories based off of that five point scale so one to three it was you know um non-essential and then the four to five responses were essential okay so they were asked also um should we have subscales on this instrument we they asked you know how much food water and prescription medications and medical supplies is considered prepared for a disaster is it three days is it one week is it one month what is it we asked them how should respondents answer the questions about the disaster Supply kit items and we also asked how should the instrument be scored we included um two open-ended questions he said if a supply kit item is named something different in your community because remember this is an international study please let us know and that's where your diapers versus nappies come for and all of your portable electric lighting also your um coolers all all of those things go by different names in different countries um and then we also asked them did we miss any preparedness items or actions and then we gave them demog graphic data form so the results um we had 178 participants uh only 131 actually left their email addresses for the prospective rounds but 178 was good for the initial it had we had 34 different countries represented 87% were experts 12% were Community stakeholders and look at all of the different disciplines that were represented in this here's a kind of a pictograph of the different countries 34 different countries um so the only we didn't have anyone on in South America on that continent no none of those countries participated um or Russia but pretty much the rest of the world had at least one person um participate so here's the result of round one no items none of the questions achieved consensus to be discarded off of the instrument but 35 items achieved consens of to move on to the pilot test participants agreed that there should be subskills um how much extra food water medication and supplies did not achieve consensus at all um and it was undecided how respondents should answer questions about supplies or how the instrument should be scored so we asked them these things again and round two but we eliminated the response options that received the lowest votes in round one so we decreased the response options for round two uh six new items were added uh due to the qualitative data from round one and you can see them right there um 18 team items were edited due to the qualitative data uh so going back to um the first bullet point work gloves was the only Supply kit item that was added and for round two we actually forced them into a binary response no more fivepoint scale we said to them is it essential or not pick one so results from round two no items achieved consensus to be discarded we had 84 participants at this this round 14 more items achieved consensus to move on to the pilot study it was decided that food and water would be one week's worth to be prepared for disaster prescription meds medical supplies would be two weeks worth and then they said how how we should um have the response options for disaster kit items is they could say I have this item in my home I have this item in my disas disaster Supply kit I do not have this item and then um and by the way that gets at incidental preparedness versus purposeful preparedness if you understand what I'm saying and then the scoring they wanted it to be weighted in terms of the importance of the action or item actually ultimately discarded that recommendation for at least the current version of the happy because it became too confusing we want we want anyone to pick up the happy and understand how to score it so that that's gone but you might be able to use it that way in your own research so around F was really actually to help us determine how we should score the instrument we did assemble the instrument that was going to be pilot tested um we got questions that should be weighted higher versus lower obviously the things that were more essential than um you know food and water would say be the the highest scored things like you've got to have that to survive do you really need a flashlight to survive I don't know it would be nice and then our our final sample for round three was down to 79 so that brings us to our pilot study we the next step in instrument development is to Pilot test and refine the instrument we wanted a diverse sample allowing for usability for assessment of usability reliability Val validity and culture bias of our instrument so we did a cross-sectional study with a sample of New York City residents during the covid-19 pandemic um it comprised of a demographic assessment the hey on inquiries to assess the ease of use and we did this with city of of faculty staff and students oh this was a nightmare by the way um just for those of you who are students just talking about or just being honest about the whole research process we achieved IRB approval for this study like a week before lockdown so we started deploying the instrument during lockdown very the very start of lockdown of the pandemic um and the IRB requirements were that the Deans and the department heads were kind of Gatekeepers ERS so they had to forward my um my um recruitment message or not it was their choice I had no power over that so so so so so many people said no this is the wrong time to do this um the staff is very anxious I'm not I'm not forwarding it so I think if we did this pilot study not during lockdown um we might have had more participants but we still had a pretty good turnout um so we wanted to examine the validity of the new scales we did that with factor analysis and we had qualitative and quantitative data analysis performed on the respondent's experience with taking the hey so we asked them you know to rate the perceived Clarity of the happy instructions and questions the difficulty of the happy and the reasonableness of the length of the happy and we also included one open-ended question um you know that was to inquire about anything the participant would like the researchers to know about the experience of completing the hey results we completed analysis with 284 faculty staff and students um our internal consistency reliability is strong at a chbox alpha of 089 uh 080 to 089 is actually considered very good greater than 090 is considered excellent so we so close right remember this is the pilot test brand new time that we're using this instrument and then for factor analysis um for those of you that don't know instrument development the the key concept of factor analysis is that multiple observed variables I.E the hey questions we want them to have similar patterns of responses because we hope that they're all associated with the latent variable of disaster preparedness you can't directly measure that right so we had our factor analysis explain 35% of the um sample variance with factor analysis the higher percentage of variance explained indicates a stronger strength of an association between those happy questions and the concept under study which is household Mar preparedness so ideally the variance should be 60% or higher ours is only 35 which is still pretty good for social science instrument and also a brand new instrument but we fully anticipate that as as this instrument is used more and more and revisions are made that the variance explained will increase and the results so who is the best prepared and that's um I say that with hesitation because look the mean happy score was a 15.2 at8 out of 40 possible points 40 meaning that they're they're the most prepared but the faculty and staff older age the higher income and those with previous disaster experience were higher prepared than everyone else and then the respondents this is good if you want to use this instrument for you'll you'll know about researcher burden and respondent burden right it's glow for our instrument 92% of our guys said said that the instructions were extremely clear 87% said the questions were clear 78% stated that the length was reasonable and 76 said that the experience of taking the heie was easy we did have quite a few right in the qualitative remember I said we had one open-ended question um about what is your experience with taking the heie a few of them said that it caused anxiety again it was right at the start of lockdown people were wiping out all the shelves in the hardware stores and the grocery stores um but based on that feedback in the instructions for future researchers when you're using this instrument um we do ask that you disclose to your IRB that taking the happy could cause feelings of anxiety and unpleasant memories of past disasters um I've I've already submitted that statement to my IRB for the next study they don't they said that's fine still minimal risk um but something to consider uh also the qualitative data revealed that the hey helped respondents learn what's needed to be prepared made them realize they were unprepared and inspired them to develop a household mer plan so this instrument is actually serving as an intervention in itself right just the experience of taking it so we also make a recommendation for future researchers that at the end of the hey provide a link to you know um whatever your local disaster Education website is and and that could be FEMA it could be the CDC it could be the Red Cross um you know if it's outside of the country whatever your local um disaster preparedness information source is include that link because people have taken the survey they're like oh this is bad I'm not prepared what should I do to get prepared now and they click on their link and they know what to do um so construct we've got constract Criterion face and content validity support for the adequacy of our hey to capture our Essentials of a household emergency preparedness so implications for practice the hey is a valid and reliable instrument that provides researchers and community planners a replicable approach to assessment of preparedness levels and it can be used for policy development you can use it for mitigation strategy planning to decrease disaster related morbidity and mortality and increase resilience for individuals families and communities you can use it to assess preparedness levels of any population um and provide evidence to support interventions and address Health needs of community members following disasters some implications for research the next steps for the hey and any of you guys can do this right it's not just me I've got so many studies on my to-do list right now I can't do them all so this is something that you can pick up um we need a predictive validity study I keep saying that over and over again we need to to see if there is an association between being prepared for disaster and decreased morbidity IM mortality if we can establish that Association um you know we can advocate for funds to help hand out these free disaster kits to help our community members that can't afford Bo to build their own kits um we wanted to do a known group validity evaluation we haven't done that type of validity testing yet and also a test retest reliability assessment we should do that as well so those two are quick and easy things that you guys could do uh researchers emergency planners and Educators may use this hey for non-commercial purposes okay you can't make money off our instrument but you use it for non-commercial purposes without any cost at all whatsoever to you following the um under the following conditions you do cite us in your Publications as the hey developers if you translate the hey or you alter it modify it in any way disclose that in your publication but also let us know because if you you're changes might are are most likely going to get make the instrument better so we want to incorporate that into um subsequent versions and also always do the psychometric data analysis for the instrument um especially your Publications people need to understand how it's um operating in the real world um so that they can make a judgment if they want to use a hey in their their research uh and like I said all of that information will inform future modifications of the hee so for a copy of the survey and the instructions and how to administer and how to score it you can contact any one of us all right so last topic pretty much of the day nurses taking on ready Readiness measures also known as entor entor is a nurs driven household emergency preparedness intervention that I hope to offer in the hospital setting to older adults people with chronic illnesses caregivers of medically failed patients and new parents um this was modeled after that Community intervention I already told you about storm seniors taking on readyy me ready Readiness measures that was taught by Emergency Management Personnel at the senior centers those guys at senior Cent senior centers are pretty healthy they're mobile they've got a good social support system system they're really active so we want to um Target the folks that are you know more sick more isolated homebound those folks um but enorm is an all hazards disaster preparedness intervention so it's rep it's possible to replicate this nationally we did our first entor um pilot study in a hospital in Brooklyn and we did it with the niku which is the neonatal intensive care unit and the newborn Nursery we did it with those parents there so um the hey so my dissertation study the hey Deli study and the hey cuni pilot study we're all done with no funding at all whatsoever free I I was able to do this um for this study not not so much we were funded by um w w Cornell's Medical colleges um clinical and translational Science Center pilot award seed funding and we did have two research assistants that I'd like to acknowledge so the aims of our pilot study we wanted to expand that reach of Endor to the vulnerable populations and we also wanted to evaluate the effectiveness of enorm for increasing levels of preparedness and as evidenced by knowledge and behavior so this enorm intervention enables uh the household to meet Federal Emergency Management recommendations for household emergency preparedness it enables them to safely shelter in place or evacuate quickly with their supplies if needed um here's an ins I look at the bucket that I use for my intervention studies I like this bucket um because it can be converted to a toilet if the sewer services are lost uh when you're in a city with highrises a lot of times during disasters power outages um the pumps stop working so you lose sewer in those high-rise buildings so we can use this as a toilet instead and here's the contents of this commercial kit so it's got everything that I put in my own household disaster kit but um in more condensed um a format so you've got your multi-tool ponchos your whistles your Delight stick all of that stuff is in there um they've got water in little baggies but they also have water purifying tabs and here's your food rations they've got all food rations included so here's our methods for Endor worms so that you may replicate the study in your populations this this is still a brand new intervention that can be brought to anywhere that you choose pretty much you can do this one onone with people you can have it in the classroom format you could do it via teley visit however you want to do your entor intervention you can do it so what we do is we first administer the hey to determine Baseline level of preparedness unfortunately during my interor pilot study I was still developing the heie so we used the FEMA checklist as our instrument not a valid and reliable instrument I had to disclose that in my limitations from here on out I'm using the hey though and you can provide the information um for for us we the nurses educated the participants on that Ready New York my plan booklet provided guidance on how to complete that booklet um the the parents did that on their own time during the hospital stay the nurses were then check for completion of the booklet they actually do did the participants do their part of the homework if so then they received a complete disaster Supply kit for free and then we administered the hey again to deter change in level of preparedness so we also did collect qualitative implementation data from the nurses we wanted we asked them like how how did that go for you do you have time to do that was that a good meaningful um intervention can you do that in your practice going forward results we had 68 new parents that was all we could afford with our limited funding um all of the funding uh pretty much went to the disaster kits by the way they those ones that I showed you they run between 105 and 111 dollar depending on the demand the market demand for disaster kits at the time so we had 68 parents and three of our nurses participated um and the mean uh Hey score I should say the mean FEMA checklist score went from a 14% to 97% pre-intervention to post intervention 100% would have been perfectly prepared the barriers was the weight of the kit so in this specific setting we had new moms here that were um not permitted to lift heavier than I think it was 10 pounds the weight of the kit is 23 pounds so that was limitations they they had to have somebody help them go home um anxiety of the parents of course we did this pilot study in the middle of the pandemic so um the parents did Express anxiety about not being prepared to bring a child home in the middle of the pandemic let alone prepare for a disaster that might not ever happen so that was a limit a barrier and then the nurses reported that they frequently needed to follow up with the parents like did you complete your booklet yet are you don't need your booklet can I check your booklet so that was um a mild irritation for the nurses the facilitators were the actual booklet and the kit the nurses said if they didn't have those available they probably would not do this intervention that that was they were necessary um however their part the intervention was fast it only took them five or 10 minutes to go through that booklet and check for completion so if you're not offering like a full-blown class on it um this could be a quick and easy uh intervention and the the cost was around 1112 per per participant which sounds Hefty right but say one of these infants so infants are extremely um especially our niku babies if if they're exposed to temperature extremes or poor air quality and say like a storm shelter um type scenario they get sick real sick so we need to compare that $112 intervention to the cost of a hospital stay if they got sick during the disaster so the implications for your research we want to Pilot test this Endor intervention in other patient populations and settings evaluate now so we asked the nurses what was their experience with um providing intervention now we want to ask the participants what's their experience did they find it meaningful and helpful and again we want to do those longitudinal studies to determine the association between preparedness level and disaster resilience so the nurse's role these are my last few slides and then I'll open it up to question questions um nurses as leaders in disaster preparedness and response a call to action appeared in our Journal of Nursing scholarship in 2016 and the purpose was to develop a vision of the future of disaster nursing for disaster events and public health emergencies we see nurses and disasters it's usually us evacuating hospitals or taking care of the sick and injured and it's rarely discussed um what our role is in preparedness right so we want wanted to develop a national set of disaster nursing competencies integrate opportunities into multiple delivery platforms and schools of Nursing and continuing educational opportunities want nurses to possess the minimum knowledge based skills and abilities um to respond to disaster prepare for them and of course we want nurses to be able to respond directly or provide indirect support like a shift courage for other nurses deploying so for the non- nurses in this room um utilize us invite us to your disaster drill help us disseminate disaster education uh coming soon I'm currently doing a systematic review on the effectiveness of household emergency preparedness interventions with an international team inition and plinary team as well you can see the authors listed there um through Cochran Library so we just concluded data extraction and now we're starting data analysis spoil alert interventions du improve preparedness knowledge actions and behaviors but we still don't know if it improves survivability here's my references hold on looks like I'm skipping stuff here I am let me go back real quick um so we want nurses to always promote preparedness amongst individuals in their care and that includes families communities and organizations um and demonstrate commitment to professional preparedness here this says nurse role but this should say everybody's role so I'm taking you out of your academic role I'm taking you out of your researcher role I'm putting you as like the good neighbor um you should serve as a trusted risk Communicator tell people in your life the importance of disaster preparedness be the good neighbor I'm not telling you to go and host your elderly and disabled and um frail Neighbors in your house but go go through your neighbor and say hey can I pick up a case of water for you at the store and offer to carry it inside for them help them out say can I can I drive you over to the storm shelter um of course everyone in this room can participate in disaster drills um so tricky trades and Gifts in general whenever I'm asked to contribute something to like a charity auction I always assemble a disaster kit and give that and also um just gifts in general like graduation gifts um housewarming gifts wedding gifts who doesn't want a disaster Supply care right they make um great gifts for every single occasion if you have like a church project a Boy Scout project Girl Scout project um nursing our Honor Society Sigma Theta tow you can assemble disaster kits and hand them out to um vulnerable community members and the biggest thing that you could do is actually be prepared yourself because then you're going to be less likely to be a burden on on the community so for questions um you know here you can find me on Research gate on Twitter on LinkedIn um I'm I'm pretty friendly I think to think all my references I can share copies of these with individuals I can't post them publicly because they're not open access one of them is open access the other ones I have to email you um and that's that's what I got all right Tara that was uh that was a lot of information you you I mean I was you know I knew you were doing all this work but you put it all together in one package I mean you you're like a oneperson uh industry here uh and it's really impressive and I have to say that the research it's well conceived um and and and boy you are a Workhorse and you've really done some impressive work in this area so uh congratulate you for that um so as Ted indicated uh please submit your questions via chat and uh uh I just wanted to I guess the first question um was where does this stand in terms of I know you're doing a lot of work with a nursing profession and Outreach uh and and where does that stand in terms of those efforts um well like I said I'm still I'm still pretty new in my academic career um and getting any research done over the last two years has been horrible a couple of my studies were on hold in fact I was doing my next um Endor study in a on a tatry unit like it's a step down unit in the hospital like folks are not sick enough to be an ICU they're not well enough to be on a regular floor um and I had to pull out of that study because they had like a 60 or 40% employee vacancy rate a bunch of Travelers nobody wanted to do the intervention or cared about it so that was disheartening so now I'm doing an Endor study with community members I'm trying to recruit 30 right now but I guess the biggest part is doing stuff like this this presentation here I'm presenting something similar learn about two weeks to a nursing audience I want people to know about the instrument I want people to know about this quick and easy intervention so that everyone else can start doing this as well and it doesn't have to be researchers it just could be Public Health people Emergency Management people and their normal daily basis but that is my goal get this stuff out there show that it's easy to do it's inexpensive um and encourage everyone to do it okay we have some questions coming in uh the first one was uh and I'm sure we'll send this around uh we can send a link but the how do people find the instrument easy they like it uh I mean and that's that's not no how do I mean are the participants how find it yeah how do they find it yeah so you just email me um and I I could put my let me put my email in the chat box and I'll send you a copy of it okay um so let's see so we've got another question here uh and everybody please send your questions via the chat feature uh how successful have you been in in mandating emergency preparedness in nursing curricula um and in other Health Professions I mean they know the port terce just trying to save the nursing profession you can't do the whole health health field but go ahead what how how how's that working I think it's working well at Hunter College I teach a disaster nursing elective to the under grads I've done it um two years now because it was just approved two years ago um and it's it's popular I it's full um that being said I should probably do uh a knowledge Effectiveness research study in my actual class so that I can share that with the the nursing curricula world and say hey this this actually improves disaster knowledge um I don't know if it improves willingness to respond during disasters I'm some times trying to read the room and possibly Gathering that I'm dissuading some of the students from becoming ER nurses because the ER nurses are the frontliners like they get everything first but again that that is just me thinking I'm reading the room I need to actually evaluate you know are am I actually making a difference do these people want to go into disasters now after this class um but yeah I I share that I talk about that you know with other colleagues and other institutions we definitely have disaster nursing courses um starting up around the country um for nursing curriculum in general in the United States they do mandate that we talk about disasters um but usually it's like one class in one semester they'll hear about it versus a full-blown semester of it as say an elective they're hearing about it just not enough okay um you know and I know we've we've talked uh uh independent of this event about looking at curricular issues crossy and you know as you point out New York is disaster prone city um and and I would going back to uh even Sandy um you know I think we look casually at that and I think it was uh I think there were 33 fatalities in in the city during Sandy something like that and I think three of them or maybe even four had a direct connection to cuni uh they were cuni students um and so we are very much in and of the city and so this this is a really an important uh uh area uh and and one that we all all should recognize across the Health Professions as well as obviously Emergency Management so what are your thoughts in terms of uh you know if you are the emergency manager and and one of the things we're we're cognizant of is this kind of uh uh disconnect if you will between the world of health and the world of Emergency Management as much as we try to get over it and you would think in the mid of Co that it would be stronger now than ever uh and it still kind of exists there uh what advice would you give for the Emergency Management Community to try to engage more seriously around these issues yeah so for Emergency Management again I would say utilize your nurses in your community uh I can't tell you guys enough we are the number one most trusted profession we say that disaster preparedness is important um folks will probably listen to us so empower the nurses in the community with the tools and the knowledge to help spread that information um the regular nurse doesn't know what I know in fact there's only a few of us disaster nurse researchers throughout the world um so we are trying to get the word out to nurses but um I don't know how to to explain it other than that you've just got to use your nurses of course um you ask us our opinions um maybe even use you know our home care nurses in my in in my study setting for my dissertation study the Home Care nurses didn't talk about disasters at all whatsoever and I feel like that's something that that should be top of their thing you know if if somebody's sick enough to require a home health care nurse and a disaster hits and no nurse can actually get to that person who's taking care of them who who's giving them their medical supplies the organizations had nothing to do with that um they didn't get extra supplies so I would I would ask emergency managers to work with any kind of Health Care Facility in their Community to get the word out where are the storm shelters how do you get on the priority utility restoration list so folks that have medical needs can have priority restoration of their power or their water um especially if there's a pocket in your community where there's a whole bunch of them then they're going to send out their their trucks and their personnel to go fix what's broke there um so that that's that's what I can think of for sure hopefully I answer that question no no that was great uh one question I've got uh is uh what what funding sources have you been what's your go-to in this area or is this falling in the cracks between kind of existing research funding streams yeah so I it's funny I just had that conversation with you right before this talk I just got regret so I'm G to be um completely honest always candid um right before I signed on to this I got my reject letter for an EPA Grant not interested in in the preparedness work in the way that I was proposing um and that was the the first really big grant that I actually applied for so I got reject rejected um for me I don't know I'm still learning I I I've been applying for little grants I've got some Cy I've got two Cy grants one's $40,000 it's a climate change study so we're looking at heat stress and air pollution and how does that affect um that's another study I didn't talk about right how does that affect the the physical aspects of the person so we're doing that um and then I got some little grants to to purchase the supply kits but I haven't done much else because these these projects are consuming my life well they're I mean they're certainly worthy uh and and so we should commiserate on that and and we should talk because these are you know so Central to Notions of emergency preparedness um and so timely it would it would seem to be an area that ought to get more resources right along with all the other uh uh research streams that are out there okay um uh I'm not seeing any questions coming in but uh please feel free to send them in we'll go for a little longer here one question I had as you talked about earlier in the presentation um the uh informal networks for distribution of information and how important that was to uptake um and I think you you you made an excellent point with the the fact that you know what a household emergency kit looks like and what it contains the fact that there's so many variations of that out there right does that undermine the message and and maybe that's an area where we need better consensus or at least some some guidance and of course uh but when you talked about the social networks I was immediately drawn to the the positives obviously if you look at you know Faith communities and neighborhoods and and and extended networks you know senior groups but also the the the downside of that in terms of potential misinformation um as we've seen around you know covid vaccination uh and all that and so do you have you encountered that or had any thoughts about it the informal networks I know um one of my participants from the dissertation study said Each one teach one that was one of my themes actually and that study so um you have to find the best way to educate them to spread the correct information um and the groups that I'm thinking about they're not necessarily on the internet so much so even if it's just posting a disaster kit the FEMA check the FEMA disaster kit checklist stick that in the bulletin board in the community room or slip it under people's doors um stuff like that again equipping um all of our faith and Community Based organizations with those materials you guys can volunteer to do a talk at your church if you want to the um that Ready New York book if we have a New York crowd in here that they'll print that out nicely for you for free and ship it to you for free so you don't even have to download it off the internet if you want like a nice version of it so just getting the word out there that's all I can recommend okay uh great and uh so last uh next to last question is there anything else you want to share with the audience before we going back to the funding um that that systematic review that I'm doing so you know with NIH grants in general they don't want to fund you um for stuff that's not kind of proven so we're hoping to build evidence that interventions work with that systematic review and then I'll show combine that with the pilot studies I'm doing end term and then hopefully I'll be applying for bigger funding soon but um right now that that's all I can think about and other than that uh I'm open to collaboration I'm not sure I can accept collaborations at this time because the the my dean of research told me to take some things off my plate before I accept more projects but that doesn't mean that you can't use the instrument it doesn't mean that you can't do your own end term I'm happy to share that kind of stuff with you um but I hope you all stay in touch well uh thank you Tara that was really uh wonderful presentation uh and I'm I'm delighted to see that you're doing that cockr review and for those of you who aren't familiar that really is a standard that is a big deal uh and you're the second author on that that's really uh something to celebrate and we look forward to that coming out so uh you know keep up the good work we're going to stay in touch um and uh and and for those you know in the audience so we will post this video uh probably within a week and uh if we want to distribute some uh links uh Tara we could do that also uh some some uh materials can go out at that time uh and then I would just like to remind the audience uh real quickly of our uh next event which is April the 20th uh we're going to be having a panel discussion on Technology Innovation in the public safety sector uh and we're really pleased we have a really strong panel uh of uh academics researchers uh and practitioners who are actually innovating in this space so uh we look forward to having everybody there for that uh and so with that Tara uh once again thank you so much and thank you everyone for attending thank you guys okay bye bye