Digital Repository Doctoral Projects Spring 2023 Implementation of a Post Disaster Recovery Protocol for Tooele County, Utah Tracy Schaffer Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Schaffer, T. (2023). Implementation of a Post Disaster Recovery Protocol for Tooele County, Utah. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Implementation of a Post Disaster Recovery Protocol for Tooele County, Utah Project Title by Tracy E. Schaffer Student’s Name A project submitted in partial fulfillment of the requirements for the degree of DOCTOR OF NURSING PRACTICE Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT March 13, 2023 Date Tracy Schaffer, DNP Executive Leadership, RN, NEA-BC April 28, 2023 Student Name, Credentials Graduation Date (electronic signature) DNP, MSN/Ed, RN, CNE, COI DNP Project Faculty Name, Credentials (electronic signature) DNP, APRN, CPNP-PC, CNE Melissa NeVille Norton March 13, 2023 (electronic signature) DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. March 13, 2023 Date RECOVERY PROTOCOL 2 Table of Contents Abstract ............................................................................................................................... 4 Implementation of a Post Disaster Recovery Protocol for Tooele County, Utah ............... 5 Background and Problem Statement ............................................................................... 5 Diversity of Population and Project Site......................................................................... 6 Significance for Practice Reflective of Role-Specific Leadership ................................. 6 Literature Review and Framework ..................................................................................... 7 Search Methods............................................................................................................... 7 Synthesis of Literature .................................................................................................... 8 Disasters .......................................................................................................................... 8 Disaster Management Cycle ......................................................................................... 10 Consequences of Each Phase .................................................................................... 11 Disaster Recovery ..................................................................................................... 12 Consequences............................................................................................................ 13 Challenges and Barriers ............................................................................................ 14 Community Involvement .............................................................................................. 15 Plan ........................................................................................................................... 16 Community Education and Engagement .................................................................. 16 Resources .................................................................................................................. 17 Solution to Aid in Recovery Efforts ............................................................................. 19 Framework .................................................................................................................... 20 Discussion ..................................................................................................................... 20 Implications to Practice................................................................................................. 20 Project Plan ....................................................................................................................... 21 Project Design ............................................................................................................... 21 Needs Assessment of Project Site and Population ........................................................ 21 Cost Analysis and Sustainability of Project .................................................................. 22 Project Outcomes .......................................................................................................... 22 Consent Procedures and Ethical Considerations........................................................... 23 Instruments to Measure the Effectiveness of Intervention ........................................... 23 Project Implementation ..................................................................................................... 23 Interventions ................................................................................................................. 24 Interventions Align with Long and Short-Term Outcomes .......................................... 25 Project Timeline ............................................................................................................ 25 Project Evaluation ............................................................................................................. 25 Data Maintenance/Security ........................................................................................... 26 Data Collection and Analysis........................................................................................ 26 Table 1 .......................................................................................................................... 27 Table 2 .......................................................................................................................... 28 Findings ........................................................................................................................ 28 Strengths ................................................................................................................... 29 Weaknesses ............................................................................................................... 30 Discussion ......................................................................................................................... 31 Translation of Evidence into Practice ........................................................................... 31 Implications for Practice and Future Scholarship ......................................................... 31 Sustainability............................................................................................................. 32 RECOVERY PROTOCOL 3 Dissemination ........................................................................................................... 33 Conclusion .................................................................................................................... 34 References ......................................................................................................................... 35 Appendix A ....................................................................................................................... 43 Appendix B ....................................................................................................................... 44 Appendix C ....................................................................................................................... 50 Appendix D ....................................................................................................................... 57 RECOVERY PROTOCOL 4 Abstract When a disaster occurs, a community is impacted in many ways. Developing a Family Assistance Center plan and training a community ensures a community is better prepared postdisaster. Purpose: This project aimed to provide a continuum of care for Tooele County residents to meet the needs of those affected by a disaster. Methodology: A discussion with Tooele County Emergency Management identified a need to develop a Family Assistance Center plan and provide training to stakeholders in a rural community. A Family Assistance Center plan was implemented, and key stakeholders in Tooele County were instructed to follow a standardized approach to disaster recovery. Results: Tooele County, Utah, adopted the Family Assistance Center plan. Pre-survey results from training participants indicated (n = 13) a lack of knowledge about the importance of a Family Assistance plan and how it could aid a community's recovery efforts post-disaster. However, after training was provided, 100% of the participants reported (n = 8) adequate knowledge about the significance of a Family Assistance Center plan. Additionally, 100% of the participants said the disaster recovery plan improved their preparedness. Implications for Practice: Developing a disaster recovery protocol with a Family Assistance Center will ensure that Tooele County, Utah, is prepared. A Family Assistance Center will provide access to services essential to recovery in the immediate aftermath of a disaster. Keywords: Family assistance center, family assistance center plan, disaster recovery, disaster recovery cycle, disaster management, disaster recovery plans. RECOVERY PROTOCOL 5 Implementation of a Post Disaster Recovery Protocol for Tooele County, Utah Each year, natural and human-caused disasters impact millions of people worldwide (US Department of Veterans Affairs, n.d.). Despite the planning already accomplished by international, national, state, and local leaders, ways to reduce casualties and destruction of infrastructure in the communities are continually evaluated. Recovery is more than just rebuilding a community's infrastructure. The primary purpose of this project is to provide a continuum of care for Tooele County residents to meet the needs of all those affected by disaster, including financial burdens, emotional and physical impacts, and provide resources to help rebuild the community to recover at a faster rate. For a community to hasten the recovery process, it will need to already have in place predisaster preparedness, mitigation, and recovery capacity building (Federal Emergency Management Agency, 2011). By addressing these efforts in a community, the community is more resilient, allowing it to withstand, respond to, and recover from a disaster and return to some sense of normalcy. However, as governments look for ways to better prepare for disasters that address their unique communities, Tooele County (Utah) Emergency Management and county leaders identified a gap in recovery protocols and plans for a Family Assistance Center. Background and Problem Statement When a disaster occurs, community impacts arise in many ways. After incidents, it is vital to have post-disaster resources available. Currently, Tooele County, Utah, does not have a plan or the organizational framework for family assistance to aid the families and friends of those killed, injured, or otherwise impacted by a disaster or catastrophic incident. By developing a framework and creating a plan for disaster recovery, community members will be able to go to RECOVERY PROTOCOL 6 or contact one centralized hub and receive communication and needed resources to begin the recovery process. Diversity of Population and Project Site Tooele County, Utah, was founded in 1850. The county encompasses 7,286 square miles and is located west of Salt Lake City, and borders Nevada. It is mostly basin and mountain country, and the city of Tooele is the county seat. Box Elder, Davis, Juab, Salt Lake, and Utah are the counties that border Tooele County. The population is 72,259, with 75 percent living in the eastern valleys adjacent to the Oquirrh Mountains (Utah's Online Public Library, 2020). Tooele County is Utah's 7th most populated county out of 29 counties (Cubit Planning, Inc. 2022). The largest racial/ethnic group in Tooele County is White (80%), followed by Hispanic (13.0%) and two or more racial/ethnic groups (3.6%). Tooele County faces challenges because of its location and lack of access due to the Oquirrh Mountains separating it from Salt Lake City and the natural barriers of the Great Salt Lake and the western desert (Tooele County's Emergency Management, 2012). As a result, emergency responders outside the county may not be immediately available, making it difficult to respond and provide aid. Significance for Practice Reflective of Role-Specific Leadership The World Health Organization (WHO) defines a disaster "as a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability, and capability, leading to one or more of the following: human, material, economic, and environmental losses, and impacts" (World Health Organization, 2020 [WHO], p. 23). By their nature, disasters are unique, yet they all have a tremendous and long-lasting impact on a community. As a nurse leader living in Tooele County, Utah, the need RECOVERY PROTOCOL 7 to implement policies and procedures and identify the framework to support victims' fundamental concerns and family members following a critical incident is recognized. A literature review provides the evidence needed to implement a recovery protocol for disaster recovery and specifies the procedures and infrastructures required for a Family Assistance Center. Literature Review and Framework This literature review aims to better understand the existing research available for postdisaster recovery protocols and help implement the framework for a Family Assistance Center (FAC). As the literature was reviewed, it was quickly identified that the recommended strategies for local and state agencies implementing a FAC model come from the Federal Bureau of Investigation (FBI) Office for Victim Assistance and the National Transportation Safety Board (NTSB) Transportation Disaster Assistance Division. The themes that will guide the policy and assist in developing the needed framework for the FAC address the following fundamental concerns from the National Transportation Safety Board (Freckleton, 2022); (a) notification of involvement; (b) victim accounting; (c) access to resources and information; and (d) personal effects. In addition, the framework to help guide this project comes from the Disaster Management Cycle adopted by the WHO. Search Methods Search terms for this project include family reunification center, family assistance center, disaster recovery, disaster recovery cycle, building resilience, community involvement, disaster planning, post-traumatic stress, emergency management, vulnerable populations in disaster management, trauma-focused research studies, disaster recovery plans, and disaster recovery protocols. RECOVERY PROTOCOL 8 The databases used were PubMed, Google Scholar, and EBSCO. All research studies needed to be considered for this project due to the unique challenges of disaster-affected populations in areas and the difficulty of collecting empirical data during an actual disaster due to the unforeseeable dangers that make it impossible to go near a disaster site. Synthesis of Literature Disasters The WHO defines a disaster as "a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability, and capability, leading to one or more of the following: human, material, economic, and environmental losses, and impacts" (WHO, 2020, p. 13). Community exposure and vulnerability to disasters include natural events, human-caused intentional or accidental catastrophes, technological hazards, or a combination of factors. By their nature, disasters are unique, yet they all have a tremendous and long-lasting impact on a community. Disasters are a threat to everyone, and unfortunately, they are occurring at an alarming rate. These events include earthquakes, tornadoes, extreme wind events, school and mass shootings, and terrorism, to name just a few possibilities. Over the past 50 years, weather disasters attributed to climate change have resulted in extreme events. The good news is that early warnings, improved reporting, and disaster management have decreased the number of deaths (World Meteorological Organization, 2021). However, human-caused disasters in industrialized countries are increasing. Primarily this growth is due to fires and explosions, while chemicals and nuclear power make up only a small part of the increase (Coleman, 2006). The direct and indirect impact depends on the event type and the affected population size. The most obvious immediate impact is the health of a population through death, injury, or RECOVERY PROTOCOL 9 disease and the destruction of housing and utilities. Despite coordinated efforts, utilities can be out of service for weeks or months; for example, after Hurricane Michael (2018), electricity restoration was at one percent one month after hitting Gulf County, Florida. (US Department of Veterans Affairs, n.d.; US Energy Information Administration, 2018). A natural disaster consists of severe weather that causes significant threats to humans, property, infrastructure, and homeland security (Department of Homeland Security, 2021). Frequently, a natural disaster occurs without warning, but alternately, known weather conditions happen seasonally, and communities can prepare and mitigate risk. A human-caused disaster is any extreme hazardous event caused by mismanagement or deliberate crime. These events can include: (a) chemical and hazardous material spills, (b) transportation crashes and accidents, (c) groundwater contamination, explosions, chemical or (d) biological attacks, or (e) nuclear blasts. Other human-caused disasters include gun violence and threats posed by radical or terrorist groups (National Environmental Health Association, n.d.). The Federal Emergency Management Agency (FEMA) defines a technological hazard as any hazardous material incident and nuclear power plant failure (Technological Hazards, n.d.). Typically, there will be no warning, and often, the victims may not even know for years that they suffered exposure to a technological hazard. The number of technological incidents is increasing because of new hazardous substances and the possibility of human error. Established guidelines and procedures are followed when the President of the United States declares a national emergency. Ultimately, state and local governments share responsibility for disaster response and recovery (Federal Emergency Management Agency [FEMA], n.d.). The Robert T. Stafford Disaster Relief and Emergency Assistance Act (1988) RECOVERY PROTOCOL 10 supports governments when disasters overwhelm them and defines the scope of assistance from the federal government. Disaster Management Cycle The goals of disaster management are (a) prompt victim assistance, (b) reduce new losses from hazards, and (c) achieve optimal recovery (Warfield, n.d.). Governments plan for disasters, reduce their impact, react appropriately, and enact recovery plans by utilizing the disaster management cycle. Appropriate actions provide greater preparedness, reduce individual vulnerability, and prevent subsequent disasters. There are many different models for the disaster management cycle. The disaster management cycle describes a predictable sequence of events that can help guide planning and address all disaster phases (FEMA, n.d.). The disaster management cycle is broken up into four different phases. The four phases are (a) mitigation, (b) preparedness, (c) response, and (d) recovery (FEMA, n.d.), and they define the needs and the appropriate focus. Mitigation focuses on preventing or reducing the impact of future disasters. Planning focuses on steps to protect people and property. Mitigation includes new building codes, evacuation plans, addressing floodplains and potential eviction, and public outreach (FEMA, 2013). The preparedness phase involves community education and stockpiling critical supplies such as sanitation equipment and antibiotics. Emergency drills prepare the community and offer the opportunity to evaluate the effectiveness of current plans. Emergency managers prepare individuals to ensure they are always ready by organizing a 72-hour kit and planning their response. Community emergency response teams must work closely with local and state governments to ensure coordinated efforts (Kelly, 2020). RECOVERY PROTOCOL 11 The response phase is a time to protect people during a disaster. The focus is on addressing threats to people, properties, and businesses (Kelly, 2020). Community preparedness is a factor for the safety and wellbeing of individuals. Emergency response plans implement triage of area damage and start the distribution of recourses The recovery phase immediately follows the event and can last from six months to years, depending on the severity of the incident. A disaster can change a community, but the purpose of the recovery phase is to return the community to its new normal. The physical, environmental, economic, and social impacts make this process complex (Kelly, 2020). In addition, this phase is a time to evaluate lessons learned and improve emergency preparedness plans realizing that disaster response is continually being reexamined. Consequences of Each Phase Mitigation is a time to look for ways to prevent emergencies that may cause damage to communities, such as destroying roads, transportation services, telephone lines, and communication links. Disruption of public utilities such as water supply, sewage, and energy can often occur during a disaster. Victims can become homeless because of the damage. Damage to food sources and utilities may cause significant public health threats. Casualties may require medical care, and the disaster may destroy critical health infrastructures regionally (Noji, 1997). Disasters can also disrupt routine health services, leading to long-term health problems. Therefore, mitigation should be examined long before an emergency occurs. Preparedness can reduce fear, anxiety, and losses during a disaster. After a disaster, healthcare needs will change. Priorities will shift from an emergent need to environmental health concerns such as sanitation, ensuring food safety, identifying shelter needs, personal hygiene, clean-up, and public health surveillance (Noji, 1997). Frequently, there is a need for RECOVERY PROTOCOL 12 rehabilitation planning and identifying mental health needs. Emergency preparedness can become life or death depending on the type of disaster. Knowing what to do and where to go can help lessen the fear of many individuals and lead to a faster recovery. The response phase receives the most attention and resources. The emergency response includes saving lives, protecting property and the environment, and meeting basic human needs after an incident (FEMA, 2015). Primary health care needs are addressed during the response phase, such as oxygen needs, immediate physical injuries, firefighting, search and rescue efforts, and stabilizing the incident. How the emergency is managed during the response phase will significantly influence post-disaster recovery (WHO, n.d.). The term recovery can be somewhat misleading for many people because it suggests returning things to some type of normalcy. The recovery phase begins immediately after the threat to human life has decreased. Noji (1997) points out that disasters can affect a community's psychological and social behaviors, causing anxiety and depression for some people. Sometimes, these conditions may have a slow onset and go unnoticed until they become an emergency. In addition, when a disaster causes a displacement of a large community, there is an increased risk for communicable diseases, which can take longer to develop and are more challenging to treat due to the lack of resources. Recovery is a comprehensive approach to restoring the environment that addresses the community's social, environmental, political, and economic aspects (Education Development Center, n.d.). Disaster Recovery The first line of defense against emergencies and disasters is the local government. They can fulfill the needs of individuals, families, and businesses (FEMA, 2020). Disaster response is scalable and saves lives with better community preparation (WHO, 2007). Once a disaster RECOVERY PROTOCOL 13 occurs, it is too late to start planning a response. Therefore, the main goal of any mass casualty incident response is to provide the best possible outcome for the most significant number of people by returning the community to normal as quickly as possible (Jiang & Yuan, 2019; King, 2020). The community absorbs the full effects of any disaster, and it is at the community level with proper emergency planning where the most significant benefits occur (WHO, 2007). A study by Horney et al. (2016) states that the recovery planning process is more successful with dedicated staff and public engagement. The recovery process includes many specific events that move a community toward a new normal (FEMA, 2016). The effectiveness and outcomes of recovery are directly correlated with pre-disaster planning. Recovery is not only the rebuilding of buildings and infrastructure but also the rebuilding of people. More specifically, the rebuilding of services that support the physical and emotional wellbeing of the people impacted by the disaster. Consequences After a disaster, many different tasks need to be accomplished very quickly. Often, disaster response and disaster recovery overlap because some areas of a community may still be in the response phase while other areas of a society may already be moving toward disaster recovery. The timeliness and the capability for an initial response can make a big difference in the overall impact of a disaster. Disaster response planning can help: (a) reduce injuries and fatalities, (b) reduce the damage that may occur to buildings and infrastructure, (c) provide protection to the environment and the community, and (d) speed up the process of returning things to a sense of normalcy (Borthwick, n.d.). RECOVERY PROTOCOL 14 Rumback et al. (2016) state that disaster recoveries are understudied. By looking at the reasons for uneven recoveries, researchers find better ways to help communities. Therefore, this case study provides necessary evidence of the recovery process. The case study focused on the early recovery period of the 2013 Colorado floods. They determined that the location a household lived determined their recovery and resilience. The factors considered were hazard exposures, local government authority over recovery decisions, citizen engagement and planning, and the strength of mutual obligations. The researchers concluded that place is a crucial determinant of recovery. Challenges and Barriers With several recurring problems happening during a disaster response, Oden et al. (2012) identified four key challenges in disaster response: (a) cross-agency coordination, (b) communication, (c) information, and (d) logistics. Addressing these challenges, training, and operations can improve. Cross-agency coordination challenges refer to the difficulties agencies face when collaborating with other agencies, keeping in mind that in non-disaster situations, many of these agencies operate independently. But, when agencies fail to coordinate effectively, the response becomes fragmented and ineffective. This can lead to duplication of efforts and, consequently, resource depletion. Coordination takes place at many levels. However, challenges are decreased with coordinated efforts, organizational charts that are up to date, a clear chain of command, and coordination (Oden et al., 2012). The most cited problem in disaster management is communication breakdown (WHO, 2007). Lost and delayed information is vital to managing disasters. With good information sharing, effective early warning systems minimize suffering. During an emergency, situations RECOVERY PROTOCOL 15 change quickly, and the messaging constantly evolves. Various audiences will have different communication needs and modes. Therefore, emergency operation centers (EOC) must understand the needs and requests of the field (Oden et al., 2012). A research study by Bharosa et al. (2009) provided an overview of relevant obstacles and challenges that exist during disasters by examining the literature and observing disaster management exercises using observation and surveys. They found that understanding each other's work process and the value of shared information positively affected information sharing and coordination during a disaster. Logistical challenges during an emergency involve the ability to move many people and a lot of supplies within the disaster-affected area (Oden et al., 2012). Koseoglu & Yildirimh (2015) defines a successful aid operation as timely, balanced, and fast delivery of resources. Therefore, logistical activities are critical for humanitarian aid operations. Nevertheless, it is possible to overcome disasters with minimal losses with proper planning and community preparedness. Community Involvement The Merriam-Webster online dictionary (n.d. para. b) defines a community as "a group of people with a common characteristic or interests living together within a larger society." Thus, community preparedness is preparing for, withstanding, and recovering from disasters (US Department of Health and Human Services Centers for Disease Control and Prevention, n.d.). By working together, communities and individuals improve preparedness by formulating a better response. A culture of preparedness allows communities to manage the potential hazards following a disaster (Department of Disaster Management, n.d.). When a community understands how to respond to a threat through proper plans, effective community education, and identified resources, the community is ready when disasters strike. RECOVERY PROTOCOL 16 Plan Tooele County Emergency Management (2021) defines a comprehensive emergency management plan (CEMP) as an established framework for mitigation, preparation, response, and recovery from an incident. The CEMP is an operation reference document that facilitates coordination between responding agencies because expected actions are understood. The plan also covers the anticipated responsibilities of the local, state, federal, non-profit, and private sectors. An emergency response plan should consist of any possible emergency, the consequences, the required actions, written procedures and protocols, education, and available resources (Ready, 2021). Community Education and Engagement With proper education and training, a community becomes more resilient when they work together, understand disaster preparedness, plan for individual preparedness, and engage with community members (Federal Emergency Management Agency, 2021). One approach that is an effective tool is the Whole Community approach model to disaster management developed by FEMA (Federal Emergency Management Agency, 2011). It is by which residents, emergency managers, organization and community leaders, and government officials can understand, access community requirements, and determine the best ways to organize and strengthen their assets, capabilities, and interests. Engaging community members allows for an increase in resources, which results in a more resilient community. By staying engaged, stakeholders plan for and meet the community's needs. A Whole Community approach strengthens what already works well for a community. There are many types of communities, and a community can mean different things to different people. Still, when strengths are identified, communities have a more significant opportunity to leverage their capabilities during a disaster. RECOVERY PROTOCOL 17 The Centers for Disease Control and Prevention (2015) recommends that emergency managers understand and engage at-risk groups to participate in emergency planning and training. Knowing where these groups live and work and the best way for them to receive information is one of the ways that has been shown to be effective. Many lives can be saved in an emergency's first hours and days with an effective local response (Corbin et al., 2021). The only way a local response can be effective is through proper training and meaningful engagement in the community. The local population will be the ones leading the recovery efforts. Therefore, the ability of a community to respond to a disaster effectively and well prepared will lead to more successful emergency management in their area (WHO, 2019). Resources Disaster management resources include federal agencies and non-governmental organizations. For example, the Centers for Disease Control and Prevention provides essential response information, and FEMA supports disaster survivors (Centers for Disease Control and Prevention, 2019; Federal Emergency Management Agency, 2021). In addition, the American Red Cross and Samaritan's Purse are two examples of non-governmental organizations that provide shelter, water, hot meals, and supplies to disaster victims (American Red Cross, 2021; Samaritan's Purse, 2021). One of the emergency preparedness campaigns for communities and neighborhoods in Utah is the, Be Ready Utah (n.d.) plan. The plan provides the most potent form of community resilience: neighbors helping neighbors. The plan includes a 12-point individual, family, and community preparedness program. The plan emphasizes that individuals assemble and maintain a portable 72-hour emergency kit that contains items designed to support individuals with crucial RECOVERY PROTOCOL 18 health and personal items for 2-3 days. Emergency food supplies must be on hand with food, water, and medications since outside resources may be unavailable or very limited. Tooele County Emergency Management has created the framework within the community to help reduce the vulnerability to hazards and help the community manage disasters. They have accomplished this feat by setting up programs within the community. One of the programs they offer is Tooele Ready. This program provides information on preparing for a disaster, such as creating a family disaster plan to help families cope with disasters by preparing in advance. Tooele Ready also provides a family resource and information guide that lists basic steps to care for oneself and their loved ones (Tooele County Emergency Management, 2022a). Another option for disaster preparedness that Tooele County provides is Tooele Alerts. Community members can sign up to receive public safety alerts. The alerts are intended to provide emergency alerts and non-emergency alerts that may significantly impact residents of Tooele County. Residents can decide whether to receive the alerts via text, email, pager, or voicemail (AlertSense My Alerts, 2021). A third resource that Tooele County has available is Tooele Responds. Tooele Responds is a volunteer organization set up to help train and utilize volunteers needed for essential roles before, during, and after a disaster. They also assist in managing volunteers and donations to help a community recover quicker after a disaster (Tooele County Emergency Management, 2022c). Finally, Tooele County Emergency Management is in the process of developing Tooele Recovers. Recovery is the activity that will continue after an emergency to help restore critical functions and work towards stabilizing the community (Tooele County Emergency Management, 2022b). The vision of the recovery for Tooele County is to ensure it is smooth and efficient as RECOVERY PROTOCOL 19 the community works with many community partners to strengthen the community after a disaster. Solution to Aid in Recovery Efforts Disaster survivors and victims' families begin searching for their loved ones and requesting information immediately post-disaster. Therefore, a central meeting place where people can find information about their loved ones, gather information, and have access to services will be essential to begin the recovery process. One solution is developing a Family Assistance Center (FAC) model. Federal agencies developed the framework to aid the community and families of those impacted by a disaster (Federal Bureau of Investigation Office for Victim Assistance and National Transportation Safety Board Transportation Disaster Assistance Division [FBOIOFVANTSBTDAD], n.d.). Although the specific needs of those affected by a significant disaster will differ between survivors and victims' families, a FAC will provide a safe, central resource. The FAC concept originated from experiences with aviation disasters and terrorist attacks. Official, timely, and accurate information was consistently identified as a problem (FBOIOFVANTSBTDAD, n.d.). In addition, families requested privacy and support services while awaiting confirmation of a family member's involvement. As a result, the US Congress passed the Aviation Disaster Family Assistance Act of 1996 (FBOIOFVANTSBTDAD, n.d.). Since then, FACs have been used in more than 30 aviation, rail, and other incidents. As a result of the FACs, the impact of families' coping ability and trust in the agencies managing the incident has improved. RECOVERY PROTOCOL 20 Framework The framework utilized for this project is the Disaster Management Cycle adopted by the World Health Organization (WHO). The model suggests that each phase of a disaster is different, and planning requires different needs. Appropriate actions taken at different points of the cycle lead to better preparedness, increased warnings, decreased vulnerability, and possibly future disaster prevention (Wisner & Adams, 2002). In addition, people's livelihoods in the community need to be restored as quickly as possible. Finally, ensuring that people can withstand and recover from future disasters is paramount in the recovery phase. Discussion Communities are woven together by certain aspects that make them a community. The ability of a community to recover after a disaster involves rebuilding the community's functions, social structures, and systems following a disaster (Tooele County Emergency Management, 2022). An effective Family Assistance Center response has been shown to address the immediate fundamental needs of family members, deceased victims, and survivors following a critical incident (FBOIOFVANTSBTDAD n.d.). Implications to Practice Preparedness has been shown to aid in recovery once a disaster happens. However, it is too late to start planning once an event occurs. Recovery is only one part of the disaster management cycle, but it is critical. Developing a disaster recovery protocol with a Family Assistance Center will ensure that Tooele County, Utah, is prepared. A Family Assistance Center will provide the community with necessary information about their loved ones and access to services essential to recovery in the immediate aftermath of a disaster. RECOVERY PROTOCOL 21 Project Plan This project includes developing a FAC plan and training for Tooele County, Utah. The FAC plan is designed to be used for a major disaster or incident requiring the activation of a FAC. In addition, the FAC plan includes information on setting up a safe, secure, and centrally located place for family members of potential victims to obtain information and a wide range of support services. Project Design This quality improvement project aims to provide a standardized approach through a written plan to establish a FAC within 12-24 hours after a major disaster or mass fatality incident. With the focus of the FAC operations on the victims' families, a multi-agency operation will be staffed by individuals from many agencies and volunteer organizations to offer support to those in need. Needs Assessment of Project Site and Population This quality improvement project is intended to impact Tooele County, Utah's entire population during a disaster. The main participants will be those involved in disaster management who respond to disasters and have been affected by a major disaster or a mass fatality incident. Other participants may include visitors to Tooele County during an incident or those traveling through the community. Key stakeholders are agencies from the county and state levels. These agencies have support from local and state governments and Tooele County Emergency Management. The stakeholders share the project's vision and have assisted in aligning the project with the mission statement of Tooele County Emergency Management. RECOVERY PROTOCOL 22 According to the mission statement of Tooele County Emergency Management, they strive to make Tooele County a safer and more resilient community by coordinating emergency resources within the county during major disasters (Tooele County Emergency Management, 2022d). In addition, with the coordination of emergency resources within Tooele County during the recovery phase of a disaster, disaster survivors and victims' families will begin the recovery efforts post-disaster, leading to a more resilient community. Cost Analysis and Sustainability of Project Budgetary requirements for this project are minimal, and most of the costs will be covered by the agencies that send their staff members to the training. Costs include the following (see Appendix A): • One education and training hour for approximately 150 community partners at an average hourly wage of $25.00 = $3,750.00 education dollars. • Water and snacks for approximately ten training classes at an average of $50.00 per class = $500.00. The sustainability plan will include initial training programs for key stakeholders and community members until the FAC plan is deep-rooted into the community. Sustainability will comprise of a regular review of the FAC plan and continued disaster recovery training. Project Outcomes The following goals will measure the project outcomes of this project: • Key stakeholders and Tooele County, Utah, community members will understand the FAC plan. • Tooele County Emergency Management will adopt the FAC plan. RECOVERY PROTOCOL • 23 During disaster recovery training, key stakeholders can establish an effective FAC using the FAC plan as a standard model. Consent Procedures and Ethical Considerations Weber State University's Institutional Review Board (IRB) confirmed that this project meets the quality improvement requirements and does not require formal IRB approval. Because of the quality improvement nature and lack of human subject testing, IRB approval is unnecessary through Tooele County Emergency Management. Project surveys will be given anonymously, aggregated, and protected in a safe location. Instruments to Measure the Effectiveness of Intervention A pre-survey, post-survey, and follow-up survey (See Appendix B) will measure the project's intervention effectiveness. Pre-survey questionnaires are given to all training participants to identify their knowledge level of a FAC prior to the training. The results will help determine if the training participants are aware of the resources available in Tooele County for disaster recovery. The pre-survey results will also measure how important the training participants feel disaster recovery is to the community. After training has been completed, all training participants will be given a post-survey. The post-survey will identify if the training was effective and if training participants understand the advantages of a FAC, how it will be utilized, and how it will be activated. The follow-up survey will measure the effectiveness of the training on the FAC and the FAC plan after a disaster recovery training exercise. The data gathered from the follow-up survey will help identify any training gaps and ways to improve future training. Project Implementation This project will be implemented when the finalized FAC plan is reviewed with the key stakeholders in Tooele County. Adopting the plan will help direct multiple agencies in setting up RECOVERY PROTOCOL 24 a quick, efficient, and successful activation of a FAC within 12-24 hours after a mass fatality incident (MFI). In addition, the FAC plan is essential for the community's resilience and recovery post-disaster. The implementation of this project will be under the direction of Tooele County Emergency Management. However, local government officials must buy into the process, and FAC plan to ensure the project's success. Interventions Interventions used for this project's implementation have been a collaborative, multiagency approach to ensure the support from key stakeholders in the community. Attaining stakeholder buy-in is one of the critical steps when implementing a project. Buy-in ensures the team supports the efforts and sees the project's benefits and implications (Barnett, 2012). Early interventions involve preliminary discussions with Tooele County Emergency Management to identify the project's mutual goals and the selection of an advisory committee. The advisory team has been holding monthly meetings and receiving emails to review the FAC plan progress and to identify critical components of a FAC and how it will operate post-disaster. Having input from the committee into the plan helps to establish a standard of care for a safe, secure, and centrally located place for family members of potential victims to receive information and a wide range of support services. Because the FAC plan is essential to the success of the recovery efforts of Tooele County post-disaster, education is being provided to the community and local government officials (see Appendix C for education) on the importance of a FAC for Tooele County. For example, the local hospital holds a trauma conference each year, and the project and plan will be presented at the conference. In addition, Tooele County Emergency Management will continue to offer training opportunities for the community about the FAC plan and the vital structure and RECOVERY PROTOCOL 25 resources of the FAC when a disaster occurs. Finally, a training module has been made available to Tooele County Emergency Management for any future training that might be identified later. Interventions Align with Long and Short-Term Outcomes This project's primary goal is to establish a FAC plan for Tooele County Emergency Management to implement during a disaster. The plan will be available when establishing a FAC that is necessary to facilitate accurate information and address the needs of families and friends of disaster victims. The FAC plan is a collaborative effort of shared individuals committed to the rescue and recovery efforts of the Tooele County community. After completing the FAC plan, the plan will be regularly supported and reviewed by Tooele County Emergency Management. For the purposes of this project, a Qualtrics® follow-up survey will be emailed to training participants within one month after training has been completed to ensure quality training and a good understanding of a FAC. Project Timeline The project timeline covers the initial research and the development of the FAC plan and training through the project implementation. The timeline (see Appendix D for project timeline) progressed through the necessary interventions required for the project to meet the deadline for implementing the “Tooele County Family Assistance Center Plan.” In addition, the timeline allowed ample time for all organizations involved to participate and provide input into the FAC plan. Project Evaluation An essential part of this project was developing and implementing a FAC plan for Tooele County, Utah, educating key stakeholders in the community on the importance of a FAC, and reviewing how to mobilize and set up a FAC. Next, ensuring the training data were analyzed and RECOVERY PROTOCOL 26 adjusted for future training was imperative. Finally, project evaluation was focused on identifying the strengths and weaknesses of the dissemination of the project. Data Maintenance/Security Protecting research data is the primary responsibility of those who collect data for research. Researchers have an ethical and regulatory obligation to be good data managers and ensure data is maintained and appropriately secured. This project's data was securely retained using password protection on the computer workstation that stored all the data. The survey links were closed and only shared by the researcher. In addition, the workstation and screen saver were secured using a password or fingerprint recognition. Finally, the data collected through Qualtrics® could only be accessed using a password through Weber State University. Data Collection and Analysis Data was collected using pre, post, and follow-up surveys. The surveys were set up through Qualtrics®. Before the FAC training, all participants were sent a survey link for a presurvey to find out how much knowledge they had about a FAC. Next, participants were sent a post-survey after the training to determine if the training they received was beneficial. Finally, one month after the initial training, participants were sent a follow-up survey to find out if they had the opportunity to use the information provided in the training. The data collected through Qualtrics® was analyzed using a quantitative research method. The pre-and post-surveys were used to evaluate the instructional intervention's impact after the completed training. Pre-and post-surveys are easy to administer and have a low response burden (Davis et al., 2017). A positive change from the pre- to post-survey demonstrated the effectiveness of the training, as shown in Table 1. The surveys that were emailed out used multiple-choice questions on a five-point scale. The pre-survey provided a RECOVERY PROTOCOL 27 well-defined quantitative benchmark for analysis of the participant's knowledge of a FAC, followed by a post-survey which was essential to consider for future training. Table 1 Pre-Post Measures of Family Assistance Center Training Survey Variable 1. Knowledge of resources available Moderately knowledgeable Very knowledgeable Extremely Knowledgeable 2. Value of importance Moderately important Very important Extremely important 3. Knowledge of purpose Moderately knowledgeable Very knowledgeable Extremely Knowledgeable 4. Likely to use resources Neither likely nor unlikely Very likely Extremely likely 5. Knowledge of digital tool Moderately knowledgeable Very knowledgeable Extremely Knowledgeable 9. Likely to respond Neither likely nor unlikely Somewhat likely Extremely Likely Pre-Assessment % Post-Assessment % 38.46 7.69 7.69 57.14 0.00 28.57 7.69 38.46 53.85 14.29 28.57 57.14 53.85 7.69 0.00 57.14 28.57 14.29 15.38 46.15 30.77 0.00 57.14 28.57 15.38 0.00 7.69 57.14 28.57 0.00 15.38 30.77 53.85 14.29 42.86 42.86 Note. n = 13 in pre-assessment n = 8 in post-assessment. This table demonstrates participant responses to the Family Assistance Center training survey before and after the educational intervention. Follow-up surveys are a way for researchers to gather additional information from participants. A follow-up survey was emailed one month after the initial training, and participants were given one week to respond to the survey. Many of the follow-up survey RECOVERY PROTOCOL 28 questions were the same as in the pre-and post-survey. The idea behind the follow-up survey was to get an idea if the training participants had the opportunity to provide the FAC information to key stakeholders and to people they associate with. Table 2 Follow-up Measure of Family Assistance Center Training Survey Variable 1. Provided resources to key stakeholders Less than 2 times Less than 5 times Less than 10 times Assessment % 70.00 30.00 0.00 Note. n = 10. This table demonstrates participant responses to the Family Assistance Center training on the follow-up survey. Findings Pre-survey results revealed that many people who attended the Family Assistance Center training had little knowledge about the importance of a Family Assistance Center. However, participants felt better prepared after completing the training and the tabletop exercise. When the pre-survey results were reviewed, it was identified that questions four and five showed a decrease in how participants rated themselves. Question four asked how extremely likely the participant was to utilize the resources at a Family Assistance Center post-disaster. Question five asked the participant to rank themself on how extremely knowledgeable they were about the “Tooele Recovers” digital tool. The decrease between the pre-and post-survey is likely due to the lower number of respondents in the post-survey. Question seven of the pre-survey looked at how beneficial disaster recovery training was in the participant’s current role. Question seven of the post-survey asked the participant to rate their understanding of the disaster recovery plan in Tooele County. 100% of participants that RECOVERY PROTOCOL 29 took the survey felt they understood the disaster recovery plan in Tooele County after the training was provided. Next, question eight in the pre-survey asked the participant to rate their importance to the role of disaster recovery in Tooele County. The post-survey revealed that 100% of the participants felt the disaster recovery plan improved their preparedness. The pre-survey question asked the participant to rank themselves on how likely they were to respond to a disaster in Tooele County with additional training. Question ten on the postsurvey asked the participant if they felt they received adequate disaster recovery training for Tooele County’s Family Assistance Center plan. Of the participants that took the post-survey, 71.43% reported receiving sufficient training. Finally, the follow-up survey showed that participants had not been able to provide the FAC resources to those they associated with. This may be because the follow-up survey was emailed one month after the training, which did not allow participants time to disseminate the information. Overall, the training provided was beneficial and improved the participants' knowledge. As a result, Tooele County participants are better prepared when a disaster strikes. Strengths As the project was developed, there was an opportunity to work with community partners and create an advisory committee. It was through the advisory committee's input that the FAC plan was developed and implemented. In addition, relationship building and trust with the advisory committee members allowed for buy-in reasonably early in the project's development which became valuable as the project started moving forward. RECOVERY PROTOCOL 30 During the implementation of the project, the local hospital hosted its annual trauma conference. The organizing committee of the trauma conference requested to have the FAC information presented during the conference. Local law enforcement, emergency medical services, the local hospital staff, and the hospital administration attended the trauma conference allowing for a much broader reach than initially planned for the project implementation. Because of the value of the FAC plan and the importance of disseminating the information to Tooele County key officials, a tabletop exercise was held, and the plan was reviewed and discussed in detail. In addition, a scenario was discussed, and the implementation of a FAC was a part of the scenario permitting a deep understanding of the importance of this project. Weaknesses One of the significant weaknesses of the FAC plan development was the commitment of the advisory committee members. For example, the day of the week and time were discussed and agreed upon at the initial planning meeting. Still, it was quickly identified that many committee members had other commitments, so often, they could not attend the discussions. This weakness was addressed using an email format whereby the initial information was sent out before the meeting and again after adjustments were made to the plan. This format ensured everyone remained up to date on the FAC plan progress. During the trauma conference training, pre-and post-survey links were sent out to the participants during the conference. Unfortunately, it was not until after the conference that it was identified that the links did not work correctly, so the data obtained was invalid. Valid data were obtained at another training held approximately three months later. Some participants who attended the second training also participated in the trauma conference. Additional time was RECOVERY PROTOCOL 31 allotted for the second training, and the participants who attended the first training expressed the value of the extra time and the review of the information. Discussion Changing a community’s approach to disaster recovery is often challenging to implement, even when backed with good evidence. The reasons for the challenges are that many people do not see the importance of planning for disaster recovery until it is too late. Although each disaster is different, there are comprehensive needs among victims, survivors, and family members of those injured or presumed dead. Unfortunately, many people do not understand their needs until they are in a position where they begin looking for resources to aid in their recovery. Therefore, future training and sustainability will be imperative to ensure Tooele County’s disaster preparedness. Translation of Evidence into Practice Evidence suggests that a FAC will aid in the recovery of individuals post-disaster. Throughout the project’s development, there was a focus on the system problem and the community's needs. Engagement and community support helped to assume ownership of the improvement project leading to the project’s success. Creating a dialog between stakeholders and the end user enabled a better understanding of their strengths and weaknesses. This understanding would help to provide improved outcomes for the community. Implications for Practice and Future Scholarship Research supports the development of a FAC plan and needed training in a community to support recovery efforts post-disaster. There has been widespread acceptance that disaster recovery is only one part of the disaster management cycle. However, as the largest healthcare provider group, nurses play a vital role in caring for injured victims and families after a disaster RECOVERY PROTOCOL 32 (Harthi, et al., 2020). Nurses face many challenges when responding to disasters and caring for victims. To help bridge the gap for nurses, the knowledge in this project will help nurses improve the quality of care they provide to their patients. Ensuring nurses are prepared is the initial step in creating a disaster response plan. Improvement in the quality of care for patients involved in a disaster will occur when disaster response plans and policies are followed. Next, nurses must look for ways to provide training and offer drills and exercises for preparedness in their community. Finally, preparing the healthcare system for disaster response will help recovery efforts. Nurses should continue finding ways to improve policies and procedures for disaster response in their community. It is also advised that decision-makers and nurse leaders ensure disaster training is offered to enhance skills and knowledge so nurses can respond to disasters competently and confidently. Sustainability Discussions have transpired about future training for Tooele County residents about the importance of a FAC. One idea that has been discussed is providing training to faith-based organizations. Faith-based organizations have been shown to play a vital role in strengthening communities (US Department of Housing and Urban Development, 2001). Tooele County Emergency Management has been provided with a training video about a FAC and the FAC plan. The training video has audio and PowerPoint slides like the training provided to stakeholders in Tooele County. In addition, the training module can be added to the Tooele Recovers website for future reference. Tooele County Emergency Management plans to ensure the sustainability of the FAC plan through tabletop exercises, full-scale exercises, functional exercises, and workshops. RECOVERY PROTOCOL 33 Tabletop exercises will continue to test the plan's validity. In contrast, full-scale exercises will help participants practice response, identify gaps in the plan, and test the logistics of the FAC operations. Finally, functional exercises will test components of the plan, and workshops will help define roles and responsibilities. Dissemination Research dissemination is crucial for the project's long-term success and sustainability. While there are many dissemination methods, choosing the suitable method for this project was essential. Like other elements of this project, the way the project was disseminated met with different degrees of success. For example, the first dissemination of the project was presented to participants in an online format. There were approximately fifty attendees, which allowed for a broad reach. However, there were technical difficulties, limited participant interaction, and a higher potential for distractions. The second presentation was in an in-person format. Some of the challenges in the in-person format were location and the timing of the training. However, participants interacted well, and the presentation allowed both parties to network and form professional relationships. Poster presentations are an excellent way to disseminate research findings and promote visual networking. In addition, poster presentations are a way to communicate visually and are quick, efficient, and effective. A poster presentation at the 2023 Nu Nu Chapter Induction was another way this project’s research was disseminated. The poster presentation allowed the presenter to raise awareness of a FAC, educate the community, engage with community members, and receive feedback from other healthcare professionals. RECOVERY PROTOCOL 34 Conclusion Natural and human-caused disasters will continue to happen worldwide, leaving devasting effects in their path. Emergency preparedness is critical to the health and wellbeing of a community. Local communities are looking for ways to implement programs, develop policies, and write disaster recovery plans. Through the efforts of stakeholders and policymakers, the ongoing resilience of a community will improve with the framework in place to aid the community and families impacted by a disaster. One way to facilitate recovery is to provide timely and accurate information. A FAC is a centralized meeting place where victims and their loved ones can gather to receive information and have access to services that will be essential to begin the recovery process. 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Public Law 93-288, as amended, 42 USC 5121 et seq. Rumbach, A., Makarewicz, C., & Nemeth, J. (2016). The importance of place in early disaster recovery: A case study of the 2013 Colorado floods. The Journal of Environmental Planning and Management, 59(11). https://www.tandfonline.com/doi/full/10.1080/09640568.2015.1116981?scroll=top&need Access=true Samaritan's Purse. (2021). Ministry highlights. https://www.samaritanspurse.org Shoaf, K., & Rottman, S. (2000). Public health impact of disasters. Australian Journal of Emergency Management, 15(3), 58-63 Tooele County Emergency Management. (2021, August). Tooele County comprehensive emergency management plan https://mail.google.com/mail/u/0/#inbox/FMfcgzGlkFnGMLZcpWStJXtZMQqVtCJJ?proj ector=1&messagePartId=0.2 Tooele County Emergency Management. (2012, July). Tooele County hazards analysis. https://tcem.org/wp-content/uploads/2018/10/00017H-TCEM-EOP-Appendix-8-HazardsAnalysis-revised-1st-Draft-April-2015.pdf Tooele County Emergency Management. (2022a). Tooele Ready. https://tooeleready.org/make-aplan/ Tooele County Emergency Management. (2022b). Tooele Recovers. https://tooeleready.org/tooele-recovers/ Tooele County Emergency Management. (2022c). Tooele Responds. https://tooeleready.org/tooele-responds/ RECOVERY PROTOCOL 41 Tooele County Emergency Management. (2022d). TCEM Mission Statement 2022 Version D. https://mail.google.com/mail/u/0/#search/mission+statement?projector=1 US Department of Health and Human Services Centers for Disease Control and Prevention. (n.d.). Public health preparedness capabilities: National standards for state and local planning. https://www.cdc.gov/cpr/readiness/00_docs/capability1.pdf US Department of Homeland Security. (25, October 2021). Natural disasters. https://www.dhs.gov/natural-disasters US Department of Housing and Urban Development. (2001, August). Faith-based organizations in Community Development. https://www.huduser.gov/portal/publications/faithbased.pdf US Department of Veterans Affairs. (n.d.). Effects of disasters: Risk and resilience factors. https://www.ptsd.va.gov/understand/types/disaster_risk_resilence.asp US Energy Information Administration. (22, October 2018). Hurricane Michael caused 1.7 million electricity outages in the Southeast United States. https://eia.gov/todayinenergy/detail.php?id=37332 Utah's Online Public Library. (2020). Tooele County. https://onlinelibrary.utah.gov/utah/counties/tooele/ Warfield, C. (n.d.). The disaster management cycle. https://www.gdrc.org/uem/disasters/1dm_cycle.html Wisner, B., & Adams, J. (2002). Environmental health in emergencies and disasters. World Health Organization. Provide an active link for this reference. https://www.researchgate.net/publication/242467342_Environmental_health_in_emergenci es_and_disasters RECOVERY PROTOCOL 42 World Health Organization. (2020). Glossary of health emergency and disaster risk management terminology. https://www.who.int/publications/i/item/9789240003699 World Health Organization. (n.d.). Emergency Response, Chapter 4. https://www.who.int/water_sanitation_health/hygiene/emergencies/em2002chap4.pdf World Health Organization. (2019). Health emergency and disaster risk management framework. https://www.who.int/hac/techguidance/preparedness/health-emergency-and-disaster-riskmanagement-framework-eng.pdf World Health Organization. (2007). Mass casualty management systems strategies and guidelines for building health sector capacity. https://www.who.int/hac/techguidance/MCM_inside_Jul07.pdf World Health Organization. (2021). Principle: Actionable communications in emergencies. https://www.who.int/about/communications/actionable/emergencies World Meteorological Organization. (2021). Weather-related disasters increase over past 50 years, causing more damage but fewer deaths. https://public.wmo.int/en/media/pressrelease/weather-related-disasters-increase-over-past-50-years-causing-more-damagefewer RECOVERY PROTOCOL 43 Appendix A Cost Analysis Description Quantity Unit price Education and training for community partners covered by the participant’s agency Water and snacks for training class 150 $25.00 $3,750.00 10 $50.00 $ 500.00 Total costs involved Line total $4,250.00 RECOVERY PROTOCOL 44 Appendix B Family Assistance Center Operations Pre-Survey Questionnaire The following is an online survey that takes approximately 5-7 minutes to complete. The survey questions will be about disaster recovery in Tooele County. By participating in this survey, you are giving your consent. The results of this survey are reported using aggregated data, keeping responses anonymous and confidential. Data will be used for educational or quality improvement purposes to improve outcomes. If you have any questions, please contact tracyschaffer@mail.weber.edu 1. How knowledgeable are you of the resources available in Tooele County for disaster recovery? Not Knowledgeable 2. What value of importance do you give a disaster recovery plan for Tooele County? Not Important 3. How knowledgeable are you about the purpose of a Family Assistance Center? Not Knowledgeable 4. How likely will you utilize the resources at a Family Assistance Center post-disaster? Not Likely 5. How knowledgeable are you about the "Tooele Recovers" digital tool? Not Knowledgeable 6. I have the tools and resources I need to implement disaster recovery protocols in Tooele County. Not Likely 7. How beneficial do you feel disaster recovery training is in your current role? Not Beneficial 8. How do you rate your importance to the role of disaster recovery in Tooele County? Not Important 9. How likely are you to respond to a disaster in Tooele County? Not Likely 1 1 1 1 1 1 1 1 1 2 Very Knowledgeable 3 4 5 Very Important 2 2 3 4 5 Very Knowledgeable 3 4 5 Very Likely 2 2 3 4 5 Very Knowledgeable 3 4 5 Very Likely 2 3 4 5 Very Beneficial 2 3 4 5 Very Important 2 3 4 5 Very Likely 2 3 4 5 RECOVERY PROTOCOL 10. How likely are you to respond to a disaster in Tooele County with additional training? 45 Not Likely 1 Very Likely 2 3 4 5 I give permission for the use of this survey, or any edits needed to evaluate knowledge about disaster recovery. RECOVERY PROTOCOL 46 Family Assistance Center Operations Post-Survey Questionnaire The following is an online survey that takes approximately 5-7 minutes to complete. The survey questions will be about disaster recovery in Tooele County. By participating in this survey, you are giving your consent. The results of this survey are reported using aggregated data, keeping responses anonymous and confidential. Data will be used for educational or quality improvement purposes to improve outcomes. If you have any questions, please contact tracyschaffer@mail.weber.edu 1. How knowledgeable are you of the resources available in Tooele County for disaster recovery? Not Knowledgeable 2. What value of importance do you give a disaster recovery plan for Tooele County? Not Important 3. How knowledgeable are you about the purpose of a Family Assistance Center? Not Knowledgeable 4. How likely will you utilize the resources at a Family Assistance Center post-disaster? Not Likely 5. How knowledgeable are you about the "Tooele Recovers" digital tool? Not Knowledgeable 6. I have the tools and resources I need to implement disaster recovery protocols in Tooele County. Not Likely 7. How beneficial do you feel disaster recovery training is in your current role? Not Beneficial 8. How do you rate your importance to the role of disaster recovery in Tooele County? Not Important 9. How likely are you to respond to a disaster in Tooele County? Not Likely 1 1 1 1 1 1 1 1 1 2 Very Knowledgeable 3 4 5 Very Important 2 2 3 4 5 Very Knowledgeable 3 4 5 Very Likely 2 2 3 4 5 Very Knowledgeable 3 4 5 Very Likely 2 3 4 5 Very Beneficial 2 3 4 5 Very Important 2 3 4 5 Very Likely 2 3 4 5 RECOVERY PROTOCOL 10. How likely are you to respond to a disaster in Tooele County with additional training? 47 Not Likely 1 Very Likely 2 3 4 5 I give permission for the use of this survey, or any edits needed to evaluate knowledge about disaster recovery. RECOVERY PROTOCOL 48 Family Assistance Center Operations Follow-Up Survey Questionnaire The following is an online survey that takes approximately 5-7 minutes to complete. The survey questions will be about disaster recovery in Tooele County. By participating in this survey, you are giving your consent. The results of this survey are reported using aggregated data, keeping responses anonymous and confidential. Data will be used for educational or quality improvement purposes to improve outcomes. If you have any questions, please contact tracyschaffer@mail.weber.edu 1. How knowledgeable are you of the resources available in Tooele County for disaster recovery? Not Knowledgeable 2. What value of importance do you give a disaster recovery plan for Tooele County? Not Important 3. I know and understand the disaster recovery plan for Tooele County. Disagree 4. How knowledgeable are you about the "Tooele Recovers" digital tool? Not Knowledgeable 5. I have the tools and resources I need to implement disaster recovery protocols in Tooele County. Not Likely 6. Rate yourself on how you understand the Disaster Recovery Plan in Tooele County. Not Knowledgeable 7. I feel the Tooele County Disaster Recovery Plan has improved disaster preparedness in Tooele County. Disagree 8. I can support Tooele County's Disaster Recovery protocol with the knowledge I have. Disagree 9. How many times have you provided resources about Tooele County's Disaster Recovery Plan to key stakeholders? 1 1 1 1 1 1 1 1 2 3 4 5 Very Important 2 3 4 5 Agree 2 2 3 4 5 Very Knowledgeable 3 4 5 Very Likely 2 2 3 4 5 Very Knowledgeable 3 4 5 Agree 2 3 4 5 Agree 2 < 2 times 1 Very Knowledgeable 3 4 < 5 times 2 3 5 < 10 times 4 5 RECOVERY PROTOCOL 10. How likely are you to participate in additional training about disaster recovery? 49 Not Likely 1 Very Likely 2 3 4 5 I give permission for the use of this survey, or any edits needed to evaluate knowledge about disaster recovery. RECOVERY PROTOCOL 50 Appendix C Objectives • Define Family Assistance Center and why it is important • Situational Awareness • Identify: • What a Family Assistance Center may provide • What a Family Assistance Center does not provide Tooele County Family Assistance Center Plan Tracy Schaffer DNP-Student, RN October 24, 2022 Figure 1: Tooele T. Adopted from: “Tooele High School Class of 1963” Steve Bunn, (n.d.), retrieved from https://www.tooelehigh1963.com/ • Family Assistance planning Figure 1: Awareness Compass. Adopted from: “How Situational Awareness Protects Social Workers” by Timothy Dimoff, 2017, retrieved from https://sacsconsulting.com/2017/03/21/situational-awareness-protects-socialworkers/ Figure 1: Hurricane Ian destruction. Adopted from: “See Dramatic Photos of Hurricane Ian’s Widespread Damage Across Florida” by Nelson Oliveira, 2022, retrieved from https://www.cbsnews.com/news/hurricane-ian-photosvideos-florida-tropical-storm-damage/ Figure 1: Bus crash. Adopted from: “Four Dead, Others Critically Injured in Tour Bus Crash Near Bryce Canyon” by McKenzie Stauffer, 2019, retrieved from https://kutv.com/news/local/tour-bus-crashes-near-brycecanyon Family Assistance Center Overview and Purpose • “A Mass Fatality Incident (MFI) is defined as an incident, disaster, or public health emergency where more human deaths have occurred than can be managed with local or regional resources (Texas Department of State Health Services, 2016, p. 1).” • Within 12-24 hours after an MFI, a Family Assistance Center(FAC) is established. • The FAC operation is staffed by many organizations, and individuals from social services, volunteer groups, and government and non-governmental agencies. • The supporting efforts that address the fundamental concerns of victims and their family members following an MFI. Significance Without the needed framework and plan for disaster recovery, community members will have a delay in the recovery process which may affect a community’s response for future events (Federal Emergency Management Agency, 2011). Fundamental Concerns • Fundamental Concerns • Victim Accounting • Where are they? • Search & rescue, transported, hospitalized • Search & rescue of fatalities • Victim identification, death certificates Figure 1. Two siblings. Adopted from “3 survival stories from the worst disaster you never heard about” by Joy Maluyo, 2019, retrieved from https://www.worldvision.org/disaster-relief-news-stories/survival-stories-worstdisaster-you-never-heard-about RECOVERY PROTOCOL 51 Fundamental Concerns Fundamental Concerns • Access to Resources & Information • How do I stay informed and get help? • Basic needs & support services • Investigative updates • Financial, logistical, & legal assistance • Personal Effects • Where are their belongings? • Recovery processing & return • Associated and unassociated Figure 1. Large amount of resources. Adopted from “Where to turn for help before and after a disaster” by Tony McReynolds, 2017, retrieved from https://www.aaha.org/publications/newstat/articles/2017-09/where-to-turn-for-help-beforeand-after-disaster/ Affected Populations: Victims, Family Members, Others Victims Family Members Others Fatalities What is the definition of a family member? Witnesses Injured, Uninjured Pets? Community Members Special Considerations: Diversity and Inclusion • Age/development o Children o Elderly o Unaccompanied minors • Education • Race/ethnicity/culture • Hobbies • Language • Spirituality/religion • Socioeconomic status • Access and functional needs • Gender Identity/sexual orientation • ….others… • Background o Personal o Professional Figure 1. Moving belongings. Adopted from “The biggest US weather catastrophes of 2016 that cost billions” by Daniel Bukszpan, 2016, retrieved from Affected Populations: Response Community First Responders Other Response Groups • Law Enforcement • Local Law enforcement • Tooele County Sherriff’s Office • Fire and Emergency Services (EMS) • Hospital • Local or State Emergency Management Offices • NTSB • American Red Cross • Medical Examiner or Coroner Addressing Family Member Concerns PROACTIVE AND REACTIVE COORDINATED INTERAGENCY EFFORT INTEGRATED PLANNING AND OPERATIONS SPIRIT OF PARTNERSHIP FOCUS ON EXPRESSED NEEDS Figure 1: Diversity and Inclusion. Adopted from “Building a successful DE&I strategy: A step by step guide ” by PageUp (n.d.) Retrieved from https://www.pageuppeople.com/resource/building-a-successful-dei-strategya-step-by-step-guide/ Family Assistance May Provide Gaining Situational Awareness Figure 1. Fishing boat with shark. Adopted from “Obtaining situational awareness”, by Britannica Knowledge Systems, 2021, retrieved from https://www.britannica-ks.com/blogobtaining-situational-awareness/ • Number of people involved in the incident? • Number of family groups? • Ages of people involved? • Where did the incident occur? • Was there a postincident fire? • What is the condition of the post-incident infrastructure? • What is the condition of the bodies? • Are there fatalities? Is the incident allfatal? • Are there survivors? • Have survivors been transported to the hospitals? • Where do family members of those involved live? • Are there foreign nationals involved? • ??? Factual information Consistency (routine) – predictability Safety and security from the public and media Realistic expectations Support during the grieving process A place for people to get answers Reduction in stress and anxiety RECOVERY PROTOCOL 52 It May Also Include Family Assistance May Provide Factual information Consistency (routine) – predictability Safety and security from the public and media Realistic expectations Support during the grieving process A place for people to get answers • Legal advice • Investigative updates • Spiritual care • Human connection • Mental health support • Recovery/Return of loved ones • Comfort animals • Words of encouragement • Respite care • Explanation of process • Identification of loved ones • Setting realistic expectations Reduction in stress and anxiety Figure 1. Child being carried. Adopted from “Helping children cope with emergencies” by Centers for Disease Control and Prevention, 2020, retrieved from https://www.cdc.gov/childrenindisasters/helping-childrencope.html • Behavioral Health Services • Spiritual Care Services Family Assistance Does Not Provide • Public Health • Medical Examiner’s Office • Closure • All the answers • Support for all needs • Eliminations of legal actions • Law Enforcement Entities Involved in Family Assistance Operations Planning • Fire and Emergency Medical Services • Emergency Management • Hospital • Death Care Industry • Department of Human Services Planning, Training, and Exercises Workshops Tabletop (TTX) Functional Full-Scale Schedule recurrent training • Define roles and responsibilities • Test validity of the plan • Test specific components • Practice response, identify gaps • Logistics of family assistance operations • Movements, materials Family Assistance Center Layout • Practice, practice, practice Figure 1. Layout of a Family Assistance Center. “Adopted from Mass Fatality Incident Family Assistance Operations” by Federal Bureau of Investigation Office for Victim Assistance and National Transportation Safety Board Transportation Disaster Assistance Division. (n.d.). (n.d.) retrieved from https://terrorvictimresponse.ca/wp-content/uploads/2013/10/Mass-Fatality-Incident-Family-AssistanceOperations.pdf Tooele Recovers Tooele County Emergency Management is developing Tooele Recovers. The vision of the recovery for Tooele County is to ensure it is smooth and efficient as the community works with many community partners to strengthen the community to overcome the disaster’s effects. Questions Figure 1. Tooele Recovers Logo. Adopted from “Tooele Recovers” by Tooele County Emergency Management, 2022, Retrieved from https://tooeleready.org/tooele-recovers/ Figure 1: Jacob City Fire. Adopted from “Jacob City fire grows dramatically, forces campers to evacuate Middle Canyon area east of Stockton: blazes burning in 6 Utah RECOVERY PROTOCOL References • Britannica Knowledge Systems. (2021, May 3). Obtaining situational awareness. https://www.britannica-ks.com/blog-obtaining-situationalawareness/ • Bukszpan, D. (2016, October 7). The biggest US weather catastrophes of 2016 that cost billions. CNBC. https://www.cnbc.com/2016/10/07/the-biggest-usweather-catastrophes-of-2016-that-cost-billions.html 53 References • Dimoff, T. (2017, March 21). How situational awareness protects social workers. SACS Consulting & Investigative Services, Inc. https://sacsconsulting.com/2017/03/21/situational-awareness-protects-socialworkers/ • Bunn, S. (n.d.). Tooele high school class of 1963. https://www.tooelehigh1963.com/ • Federal Bureau of Investigation Office for Victim Assistance and National Transportation Safety Board Transportation Disaster Assistance Division. (n.d.). Recommended strategies for local and state agencies. https://terrorvictimresponse.ca/wp-content/uploads/2013/10/Mass-FatalityIncident-Family-Assistance-Operations.pdf • Centers for Disease Control and Prevention. (2020, September 1). Helping children cope with emergencies. https://www.cdc.gov/childrenindisasters/helping-children-cope.html • Federal Emergency Management Agency. (2011, September). National disaster recovery framework: Strengthening disaster recovery for the nation. https://www.fema.gov/pdf/recoveryframework/ndrf.pdf References • Frecklton, D. (2022, January 28). Family assistance operations: The big picture. [PowerPoint Slides]. National Transportation Safety Board • Malujo, J. (2019, April 9). 3 survival stories from the worst disaster you never heard about. World Vision. https://www.worldvision.org/disaster-relief-newsstories/survival-stories-worst-disaster-you-never-heard-about • McReynolds, T. (2017, September 18). Where to turn for help before and after disaster. AAHA. https://www.aaha.org/publications/newstat/articles/201709/where-to-turn-for-help-before-and-after-disaster/ References • Texas Department of State Health. (2016, September). Family assistance center toolkit: Technical guidance: Version 1.0. https://www.dshs.texas.gov/commprep/response/5ToolsAndInfo/FAC_Toolkit_V 1-0_09-1-2016.pdf • Tooele County Emergency Management. (2022). Tooele Recovers. https://tooeleready.org/tooele-recovers/ • Van Walkenburg, N. (2022, July 10). Jacob City fire grows dramatically, forces campers to evacuate Middle Canyon area east of Stockton; blazes burning in 6 Utah counties. Gephardt Daily. https://gephardtdaily.com/breaking/jacob-cityfire-grows-dramatically-forces-campers-to-evacuate-middle-canyon-area-eastof-stockton-blazes-now-burning-in-6-utah-counties/ References • Oliveira, N. (2022, September 30). See dramatic photos of Hurricane Ian's widespread damage across Florida. CBS News. https://www.cbsnews.com/news/hurricane-ian-photos-videos-florida-tropicalstorm-damage/ • PageUp. (n.d.). Building a successful DE&I strategy: A step by step guide. https://www.pageuppeople.com/resource/building-a-successful-dei-strategy-astep-by-step-guide/ • Stauffer, M. (2019, September 21). Four dead, others critically injured in tour bus crash near Bryce Canyon. KUTV. https://kutv.com/news/local/tour-buscrashes-near-bryce-canyon RECOVERY PROTOCOL Tooele County Family Assistance Center Plan Training Module Tracy Schaffer DNP-Student, RN 54 Objectives • Define Family Assistance Center and why it is important • Identify: • What a Family Assistance Center may provide • What a Family Assistance Center does not provide Figure 1: Awareness Compass. Adopted from: “How Situational Awareness Protects Social Workers” by Timothy Dimoff, 2017, retrieved from https://sacsconsulting.com/2017/03/21/situational-awareness-protects-social-workers/ Figure 1: Hurricane Ian destruction. Adopted from: “See Dramatic Photos of Hurricane Ian’s Widespread Damage Across Florida” by Nelson Oliveira, 2022, retrieved from https://www.cbsnews.com/news/hurricane-ian-photos-videosflorida-tropical-storm-damage/ Figure 1: Bus crash. Adopted from: “Four Dead, Others Critically Injured in Tour Bus Crash Near Bryce Canyon” by McKenzie Stauffer, 2019, retrieved from https://kutv.com/news/local/tour-bus-crashes-near-brycecanyon Family Assistance Center Overview and Purpose Significance • “A Mass Fatality Incident (MFI) is defined as an incident, disaster, or public health emergency where more human deaths have occurred than can be managed with local or regional resources (Texas Department of State Health Services, 2016, p. 1).” Without the needed framework and plan for disaster recovery, community members will have a delay in the recovery process which may affect a community’s response for future events (Federal Emergency • Within 12-24 hours after an MFI, a Family Assistance Center(FAC) is established. • The FAC operation is staffed by many organizations, and individuals from social services, volunteer groups, and government and non-governmental agencies. • The supporting efforts that address the fundamental concerns of victims and their family members following an MFI. Management Agency, 2011). Figure 1. Holding hands. Adopted from “Give with a warm hand” by Sandy Ameer-Beg, 2021, retrieved from https://www.linkedin.com/pulse/give-warm-hand-sandy-ameer-beg Fundamental Concerns • Victim Accounting Fundamental Concerns • Where are they? • Search & rescue, transported, hospitalized • Search & rescue of fatalities • Victim identification, death certificates • Notification of Involvement • Are they involved? • Initial notification • Immediate factualinformation Figure 1. Two siblings. Adopted from “3 survival stories from the worst disaster you never heard about” by Joy Maluyo, 2019, retrieved from https://www.worldvision.org/disaster-reliefnews-stories/survival-stories-worst-disaster-you-never-heard-about RECOVERY PROTOCOL 55 Fundamental Concerns Fundamental Concerns Access to Resources and Information • How do I stay informed and get help? • Basic needs and support services • Investigative updates • Financial, logistical, and legal assistance • Personal Effects Figure 1. Large amount of resources. Adopted from “Where to turn for help before and after a disaster” by Tony McReynolds, 2017, retrieved from https://www.aaha.org/publications/newstat/articles/2017-09/where-to-turnfor-help-before-and-after-disaster/ • Where are their belongings? • Recovery processing & return • Associated and unassociated Figure 1. Moving belongings. Adopted from “The biggest US weather catastrophes of 2016 that cost billions” by Daniel Bukszpan, 2016, retrieved from https://www.cnbc.com/2016/10/07/the-biggest-us-weathercatastrophes-of-2016-that-cost-billions.html Behavioral Health Services Family Assistance Could Be Spiritual Care Services Entities Involved in a Family Assistance Center Operation Public Health Medical Examiner’s Office Law Enforcement Accurate Information Travel and hotel arrangements Food and beverages Someone to listen Recovery/return of personal effects A silent presence Someone in charge Memorial/site visit Funeral assistance A secure location to grieve Charging station Clothing and toiletries Fire and Emergency Medical Services Emergency Management Hospital Death Care Industry Department of Human Services • Legal advice • Spiritual care • Mental health support • Comfort animals • Respite care It May Also Include • Identification of loved ones • Investigative updates • Human connection • Recovery/return of loved ones • Words of encouragement • Explanation of the process • Setting realistic expectations Family Assistance Does Not Provide • Closure • All the answers • Support for all needs • Eliminations of legal actions Tooele Recovers Family Assistance Center Layout Figure 1. Layout of a Family Assistance Center. “Adopted from Mass Fatality Incident Family Assistance Operations” by Federal Bureau of Investigation Office for Victim Assistance and National Transportation Safety Board Transportation Disaster Assistance Division. (n.d.). (n.d.) retrieved from https://terrorvictimresponse.ca/wp-content/uploads/2013/10/Mass-FatalityIncident-Family-Assistance-Operations.pdf Tooele County Emergency Management is developing Tooele Recovers. The vision of the recovery for Tooele County is to ensure it is smooth and efficient as the community works with many community partners to strengthen the community to overcome the disaster’s effects. Figure 1. Tooele Recovers Logo. Adopted from “Tooele Recovers” by Tooele County Emergency Management, 2022, Retrieved from https://tooeleready.org/tooelerecovers/ RECOVERY PROTOCOL 56 References • Bukszpan, D. (2016, October 7). The biggest US weather catastrophes of 2016 that cost billions. CNBC. https://www.cnbc.com/2016/10/07/the-biggest-usweather-catastrophes-of-2016-that-cost-billions.html Questions • Carlisle, N., Pierce, S., & Harkins, P. (2019, September 20). Tour bus crash near Bryce Canyon National Park leaves 4 Chinese tourists dead, 27 others injured. The Salt Lake Tribune. https://www.sltrib.com/news/2019/09/20/tourbus-crashes-near/ • Cusick, D. (2022, October 16). Weak Florida planning law boosted Ian's destructive power. E&E News. https://www.eenews.net/articles/weak-floridaplanning-law-boosted-ians-destructivepower/#:~:text=In%20Lee%20County%2C%20which%20encompasses,losses %20of%20nearly%20%246%20billion References • Dimoff, T. (2017, March 21). How situational awareness protects social workers. SACS Consulting & Investigative Services, Inc. https://sacsconsulting.com/2017/03/21/situational-awareness-protects-socialworkers/ • Federal Bureau of Investigation Office for Victim Assistance and National Transportation Safety Board Transportation Disaster Assistance Division. (n.d.). Recommended strategies for local and state agencies. https://terrorvictimresponse.ca/wp-content/uploads/2013/10/Mass-FatalityIncident-Family-Assistance-Operations.pdf References • Frecklton, D. (2022, January 28). Family assistance operations: The big picture. [PowerPoint Slides]. National Transportation Safety Board • Malujo, J. (2019, April 9). 3 survival stories from the worst disaster you never heard about. World Vision. https://www.worldvision.org/disaster-relief-newsstories/survival-stories-worst-disaster-you-never-heard-about • McReynolds, T. (2017, September 18). Where to turn for help before and after disaster. AAHA. https://www.aaha.org/publications/newstat/articles/201709/where-to-turn-for-help-before-and-after-disaster/ • Federal Emergency Management Agency. (2011, September). National disaster recovery framework: Strengthening disaster recovery for the nation. https://www.fema.gov/pdf/recoveryframework/ndrf.pdf References • Stauffer, M. (2019, September 21). Four dead, others critically injured in tour bus crash near Bryce Canyon. KUTV. https://kutv.com/news/local/tour-buscrashes-near-bryce-canyon • Texas Department of State Health. (2016, September). Family assistance center toolkit: Technical guidance: Version 1.0. https://www.dshs.texas.gov/commprep/response/5ToolsAndInfo/FAC_Toolkit_V 1-0_09-1-2016.pdf • Tooele County Emergency Management. (2022). Tooele Recovers. https://tooeleready.org/tooele-recovers/ References • Van Walkenburg, N. (2022, July 10). Jacob City fire grows dramatically, forces campers to evacuate Middle Canyon area east of Stockton; blazes burning in 6 Utah counties. Gephardt Daily. https://gephardtdaily.com/breaking/jacob-cityfire-grows-dramatically-forces-campers-to-evacuate-middle-canyon-area-eastof-stockton-blazes-now-burning-in-6-utah-counties/ RECOVERY PROTOCOL 57 Appendix D