NURS FPX 4055 Assessment 3 Disaster Recovery Plan

Disaster Recovery Plan

Persistent inequities in social and health services present major obstacles to recovery following disasters in Carterdale, Mississippi. These include poverty at 39.1% of the population, high levels of uninsured, and 73.25% of the population self-identifying as Black/African American. These conditions aggravate pre-existing situations of the population in the area prior to the arrival of the tornado. Economic, educational, and housing deficits contribute to a lack of community resilience (Capella University, n.d.). Especially hard-hit from a lack of evacuation resources, shelter, and recovery supports will be the senior, disabled, and low-income residents. Based upon the Crisis and Emergency Risk Communication (CERC) model, this plan provides equity and communication while creating interprofessional collaboration to offer the most equitable support to the residents of Carterdale.

• Scenario

On March 26, 2023, an EF-4 tornado struck Mississippi and impacted the communities of Silver City and Carterdale. Many families were provided little notice and forced to evacuate. Local health care services were further limited, as Carterdale Regional Hospital sustained major structural damage, losing both power and running water. The hospital staff could no longer sustain basic health care services. Several tornado victims in the hospital’s intensive care unit (ICU) remained in need of aid. The tornado also destroyed many hospital resources. Dr. Linh Boswell, a psychiatrist, noted that many patients were left to work through the trauma of the tornado and experienced the added grief of losing friends and family. Bill Reiner, a social worker, noted that the tornado victims who were most impacted remained the most vulnerable, as they came from low-income, high-need families and continued to face barriers to accessing and/or avoiding recovery services after cumulative trauma. These various accounts confirm the sustained, high-need recovery demands of the impacted communities of Silver City and Carterdale. They confirmed the lack of equitable service and communication gaps within the triggered disaster recovery framework.

Determinants of Health in Carterdale

Multiple health-impacting factors characterized the recovery from Carterdale’s tornadoes. These included low income and level of education, poor housing, limited health care access, and a high prevalence of disability. The community’s income level sat at a median of $30,092, compared to a significantly low per capita of $10,381, which translates to the fact that the majority of the household members had virtually no means to recover from a disaster (Capella University, n.d.). For the community, an alarming 6.5% or less of the population earned a bachelor’s degree, while approximately 65.9% of high school graduates contributed to the community’s health literacy. They assist the community’s ability to navigate the complex systems of health and disaster recovery.

An example is that approximately 17% of community members aged 65 years and under were uninsured and unprotected from the negative effects of the tornado. It resulted in an inability to maintain recovery and provide appropriate housing until the houses were fixed. Additionally, 20.6% of the community members under 65 years were disabled (Capella University, n.d.). Therefore, during the tornado, this community was likely unable to achieve safety and would encounter the impact of the tornado for both the short term and the long term, while increasingly complicating the ability to recover.

• Cultural, Social, and Economic Barriers

There are a variety of factors when it comes to how a disaster impacts recovery, including cultural, social, and economic factors. Recovering from a disaster is especially difficult for people with low incomes. With 73.25% of residents in Carterdale being Black or African American, the lack of public services due to systemic inequities and the presence of a pre-existing distrust of public services within historically marginalized communities (Capella University, n.d.) may lead to people avoiding using emergency shelters, medical services, and government services for recovery. In Carterdale, 60% of the residents are in the 60 – 69 age group, and older people, as well as people with disabilities, are often very socially isolated, lacking anyone to advocate for them in situations of need. The situation is worsened, as Carterdale has a poverty rate of 39.1%, meaning that households that are under the poverty line are unable to cover the financial costs to replace the property that was lost due to the tornado. This situation leaves them unable to cover the health costs resulting from the injuries that were sustained due to the tornado or from costs due to forced relocation (Cvetković & Šišović, 2024). These barriers to recovery from a natural disaster do not simply stack upon one another, but rather, reach a point where the barriers essentially create a cycle of disadvantage, which significantly extends the time required to recover.

• Interrelationships Among These Factors

How each element discussed previously influences the health of an entire population will be outlined in this section of the study. Shelter and health can be impacted by poverty. Residents with low health literacy due to inadequate education face difficulty with following health-related directives and navigating the federal disaster assistance programs. Multiple barriers prevent a person from seeking critically needed disaster health interventions. For example, many of the tornado survivors do not have health insurance. It is possible that the service delivery system can completely ignore elderly and disabled persons living alone, for example, an elderly uninsured disabled person living alone who does not get emergency alerts or warnings about the tornado and ends up needing to be transported to the emergency room after the disaster, but also needs assistance to evacuate (Brandt et al., 2022). Closing this cycle of vulnerability will require the application of communication and culturally appropriate health recovery strategies with an emphasis on health recovery partnerships.

Role of Disaster Recovery Plan in Reducing Health Disparities

The focus of the Carterdale disaster recovery plan is on the existing inequities in the distribution of health resources and health service access in the community. With the high poverty rate at 39.1%, disability rate at 20.6%, and the demographic prevalence of historically marginalized racial groups, the plan must actively address access inequities, as it cannot assume the availability of resources. Some strategies to fulfill the needs of residents who have barriers to accessing primary service locations include the provision of mobile health clinics, neighborhood relief centers, and multilingual emergency communication services (Leibowitz et al., 2021). The communities and locations with the greatest need of the Carterdale and Silver City populations will be the primary recipients of these services; this includes the low-income and elderly populations, who the tornado has most impacted.

The recovery plan is the removal of systemic barriers to equitable and just anti-disaster service response in the service of social justice. The regular procedures of the plan must include equitable resource distribution and active, inclusive decision-making rather than being mere aspirational statements. Local established networks along with faith-based organizations and community leaders will be incorporated into the plan (Lewin et al. 2022). The lack of faith in government services in Carterdale, due to poor funding and lack of services, means that the main focus of community outreach will be to create healthy partnerships with community-based organizations in order to engage the most impacted populations. These partnerships create opportunities to implement evidence-based and culturally appropriate services, which are therefore more likely to be used by residents.

Our complete recovery plan integrates culturally sensitive practices. Recognizing the differing educational backgrounds of residents, all printed resources will utilize plain language. We will utilize interpreters and culturally sensitive outreach to establish communication between non-English speakers and emergency services. We will train emergency responders and health care professionals to offer culturally sensitive and trauma-informed care; therefore, when you offer services to the people who have been traumatized by the death of their family members or the loss of their homes, you will have to be kind and understanding and not only offer your best clinical care (Uekusa & Matthewman, 2023). One of the primary goals of this system is to develop trust and a relationship to facilitate this primary goal of short-term recovery and long-term resilience.

Policy Impacts and Strategies for Effective Communication

Carterdale (and other similar communities) relies on disaster recovery through government-implemented health policies and regulations regarding the equitable and organized delivery of resources. Once the area is designated a disaster zone by a federal declaration, under the Stafford Act, the federal government is mandated to provide disaster relief to that area. For both the Carterdale local government and the local hospital, this is crucial as it offers them the financial and material means to provide an immediate disaster response to the affected community. Resources made available through the Stafford Act include funding for the provision of emergency medical services, temporary shelter, and other resources necessary to provide an emergency response to the disaster (Elsea et al., 2020). Following large-scale disaster events, the Carterdale community relies on the Stafford Act to provide the resources required to meet the community’s basic needs. The Disaster Recovery Reform Act (DRRA) of 2018 focuses, in the pre-disaster recovery phase, on the long-term community resiliency and the mitigation of the disaster.

DRRA is vital for communities like Carterdale with an ageing infrastructure and a 39.1% poverty rate (Congressional Research Service, 2021). There is an intersection of the Americans with Disabilities Act (ADA) and the 20.6% of Carterdale residents under 65 who identify as having a disability. The ADA mandates that all emergency shelters and health care services must be accessible to all, and it requires that all forms of communication be accessible to all.

Real-time health outcomes, displacement, and utilization patterns offer a framework for hospital administrators and city officials to identify gaps in service delivery. The framework is built on a data-driven paradigm, which offers a foundation on which to alter recovery frameworks to target the most effective outreach (Raker et al., 2020). Trace mapping aims to convert the policy framework design to measurable, equitable outcome variables, and given the prevalence of structural inequity in the entirety of the community, it is a fitting tool.

The six principles of CERC will steer recovery communication for Carterdale by employing the strategies of Be First, Be Right, Be Credible, Show Empathy, Call to Action, and Show Respect (Centers for Disease Control and Prevention, 2024a). Once the response is activated, Carterdale Regional Hospital will issue its first communication via local radio in the first hour of response activation to ensure communication reaches the rural population of Mississippi. All information will be verified by Dr. Alan Jenski and Dr. Luisa Gonzalez and will be transparent (Capella University, n.d.). The first community communication will be issued prior to the response information to the community to establish credibility, and will be issued by a community leader if possible. Each message released will communicate to the families the where, what, and who of the assistance they need to access. Communication will be developed to ensure dignity and respect for the families, primarily a Black community, and to ensure their expressed needs and their community culture are prioritized.

Impacts of Proposed Communication and Collaboration Strategies

CERC frameworks for evidence-informed communication and for CERC-guided interprofessional collaboration will be critical for achieving equitable recovery outcomes. Introducing CERC principles, along with cultural humility and standard communication methods to health professionals, emergency responders, and social workers involved in recovery efforts, will provide communication consistency across teams. This will be the case whether the team member is an ICU nurse, a nurse in a mobile clinic, or any of the many professions involved; they will be able to provide the same level of prompt, culturally relevant information (Centers for Disease Control and Prevention, 2024b). Staff will engage in scenario-based drills and practice addressing the gaps in health resource communication posed to them in the stressful, resource-scarce situation described in the accounts of Dr. Jenski and Nurse Kaley Grant, regarding their experiences in the days after the tornado disaster.

Direct methods are more effective for reaching the most at-risk populations in Carterdale, which include older adults, people with disabilities, and people living on a low income. Trained by Bill Reiner, his social work team and community health workers will provide outreach to the doorsteps of residents who do not have a smartphone or an internet connection, or who do not have the means to get the information. Door-to-door outreach will be accompanied by radio messaging and layered communication strategies that include plain language, printed materials, visual aids, and SMS text messaging. These strategies reflect the nature of the diverse population in terms of accessibility and literacy and are designed to deliver critical life safety information to every resident, with the goal of minimizing confusion and ensuring compliance with the safety instructions. This application of the CERC principles “Promote Action” and “Show Respect” is consistent with the spirit of community engagement.

Sectoral collaboration is the bedrock of a successful recovery effort. Established communication systems and regular face-to-face contact allow members of the Carterdale Regional Hospital and city staff, emergency managers, and community organization staff to collaborate in real-time on the allocation of resources and the delivery of services (Shmueli et al. 2020). The designation of a spokesperson, such as Dr. Gonzalez, along with the specification of a task, helps to define the leadership role and mitigate the difficulty of receiving too much information and the resulting confusion regarding the allocation of tasks and the responsibility of each individual in the response system. Following the Crisis and Emergency Risk Communication guidelines, especially the “Be Credible” principle, will maintain accountability and build public trust through the regular Community Updates. The integration of these suggestions into the existing disaster response system will provide better service and improve the community’s confidence and resilience to the aftermath of the March 2023 tornado and other future disasters.

Conclusion

In Carterdale, Mississippi, health and social inequities create barriers for recovery from the EF-4 tornado that occurred in March 2023. Recovery efforts require an equity and culturally based recovery plan that utilizes the CERC model aligned with the focus area of the plan, including advanced collaboration and communication methods, and targeted assistance systems. The inclusive integration of the Stafford Act and DRRA, and the ADA, in combination with trace mapping and allocation of resources based on equity and social justice, will ensure access to recovery services. Communication and collaboration are key to rebuilding trust in a community that has been historically underserved. The cumulative application of these strategies will improve recovery equity in the region and help develop resilience to adverse social and health impacts, and improve the community’s ability to withstand the continuum of future disasters.