Nassau County is located in northeast Florida. The closest metropolitan area is Jacksonville, Florida.

Nassau County is 648 square miles. It has many bodies of water including tributaries from the St. Johns River, the St. Mary s River, and t he Suwanee River. The east side of the county is bordered by the Atlantic Ocean . The total population is 73,314 with 90.8% of the population represented by Ca ucasians. The area is a mostly rural area with the main industry being tree far ming and pulp production. 10.7% of the residents are unemployed and approximate ly 28.7% receive public assistance (Nassau County Quick Facts from the US Census Bureau). Residents have access to many bodies of water and enjoy water sports as the primary form of recreational activity. Living in an area that has many wate rways puts the county residents at higher risk for potential drowning and water related accidents. Additionally, since the area is primarily at sea level the r isk for flooding is high when the area experiences severe weather such as hurric anes, tornadoes, and flooding from torrential rains. The health concern as related to Healthy People 2020 is in relation to t he quality and sustainability of the environment (Healthy People 2020, 2012) as it relates to the severe weather that can impact this region particularly during Hurricane Season which is June 1st through November 30th (NOAA, 2012). The foc us of this assessment is Emergency Preparedness and disaster prevention that Nas sau County has in place to prevent serious injuries and death in the event of a natural disaster to this area. The county continues to provide a community emergency response team prog ram and local mitigation strategy task force that work to provide safety to the residents of the county. The county works with the neighboring metropolitan are a where the nearest trauma center is located to provide disaster management serv ices to the residents of this county. Additionally, the county partners with th e local law enforcement and fire rescue stations in the larger metropolitan area to provide emergency search and rescue in the event of a natural disaster. Wor king with the Jacksonville, Florida agencies ensures that the smaller area of Na ssau County is well provided for and represented in the event of a natural disas ter. A natural disaster such as a hurricane that can produce tornadoes and wi de spread flooding affects the entire community without regard to gender, age, o r socioeconomic status. However, the population that is at a lower income level tends to be more affected by a natural disaster of this proportion as they are generally poorly prepared and lack the means to stock up on necessary resources or evacuate when recommended (NOLA, 2010). Nassau County provides a special needs evacuation program to assist in e vacuating persons with special needs such as health equipment to a special shelt er, residents must register for this program annually and this should happen bef ore a storm is approaching. The county also provides general population shelter s for residents who cannot evacuate due to limited resources such as transportat ion and/or money. Nassau County partners with various community resources that may be able to provide some assistance during the initial event or after event as the resid ents deal with the aftermath and damage that occurred. The local law enforcemen t and fire department work with the neighboring metropolitan counterparts to pro vide urban search and rescue and evacuation of stranded residents. The Nassau C ounty Health Department partners with the Florida Department of health to addres s health related issues including any outbreaks of illness or disease which can be caused by water contamination related to flooding. These departments also pa rtner with the trauma center located in the neighboring metropolitan area to pro vide trauma resource services. The Council on Aging and Elder source is two organizations that can addr ess needs of the elderly. There are several agencies that assist with providing food such as the Northeast Florida Community Action Agency and the Second Harve st Food Bank of Northeast Florida. There are homeless shelters located in the n eighboring Jacksonville community and several agencies that can assist with prov iding temporary housing such as the Florida Community Prevention Center and the

Northeast Florida Community Action Agency. The county also partners with several agencies that can assist members o f the community with the stress of dealing with the aftermath of the disaster. These may include counseling sources and/or crisis prevention. Some of these ag encies are the Department of Children and Families, the Hubbard House Outreach C enter, and the Victim Services Advocate. The main aspect of this health concern that is not being adequately addr essed is that there still appears to be people in the community that are left be hind when a disaster of this proportion affects the area. The small county gove rnment provides resources and education to its constituents however there are th ose who do not evacuate during an emergency. There are those who do not have ac cess to a fresh water supply or even adequate food resources during an emergency . When members of the community do not evacuate and try and ride out the s torm then the county must partner with the neighboring county to provide trauma services, urban search and rescue services and additional community help to thos e in need. This actually causes more illness, injury, and potential loss of lif e then if the community was adequately prepared or evacuated when ordered to do so. There is also an increase in government spending to support all of these re sources. The ultimate outcome for this community would be that all members of the community were adequately prepared should a hurricane, tornado, or flooding imp act the area. Additionally, in the event of evacuation orders, the ultimate out come would be that one hundred percent to the population is evacuated when order ed to do so. The nursing actions which a public health nurse could use to improve the community status after a natural disaster would be collaboration and referral a nd follow-up system. When the nurse uses collaboration, he or she could work wi th colleagues, academic partners, and other health professions to develop a mult iple system approach that would implement interventions to protect the at risk p opulation. The nurse could also work closely with representatives of the commun ity organizations to promote a prepared healthy community by educating the at ri sk population. The referral and follow-up system would be integral part of any nursing plan as it would enable the nurse to collaborate with multiple systems to ensure necessary resources are available to anyone within the community that needs the m. This may include shelter, clothing, money, food, clean water supply, and/or medications. The follow-up system is an important part of this process as the n urse needs to verify if the process worked, what didn t work, and how could the prog ram be improved. There are several private and public partnerships that the nurse could b uild to assist with this care plan. Private partnerships could include agreemen t with grocery stores to donate surplus supplies that weren t depleted prior to the event to be donated to those who cannot afford to buy them. A church may be abl e to assist with shelter and/or clothing donation or other charitable contributi ons. Other local businesses may be willing to also donate resources to assist w ith displaced families. Private partnerships may include soliciting members of the community regardless of his or her economic status to partner with others in preparation for the event such as organizing a volunteer drive for donation of items to create preparedness kits and then donation of these items to at risk me mbers of the community. The overall objectives for these activities would include that all of th e at risk members of the community are adequately prepared for any potential nat ural disaster and that there are no members of the community left behind if the community is evacuated. All members of the community should have access to shel ter, food, fresh water, and necessary medications. The timeline to implement new strategies should be no longer than the si x months outside of the hurricane season. This would allow all planning and imp

lementation to be completed. Following the season in which the new strategies w ere implemented, the public health nurse should do a review and interview to see what part of the plan was not met and then in collaboration with other agencies determine what needs to be changed so that the goal is met. The evaluation phase would include working with the health providers, po lice, and fire and rescue to determine if there were injuries that occurred due to unpreparedness. If there were no evacuation orders then interviews would nee d to be conducted with the county population to determine if he or she had enoug h of the necessary supplies to get him or her trhough the critical part of the s torm such as shelter, food, and water. Tools to gather this information may inc lude mailing of questionnaires to the citizens of the county, providing direct p hone calls, and even door-to-door interviewing if necessary. My perspective on efforts to protecting this community is two-fold. Fir st I felt that there was a huge effort on the part of the government including h ealth providers, police, and fire-rescue that enabled these agencies to be prepa red for any disaster. Many of the health providers, police, and fire-rescue sta ff attend specific training in search and rescue and taking care of people who h ave been injured due to a severe weather natural disaster. However, the second perspective I had was that the government is not doing enoug h to reach the community and provide education and resources for this type of in cident. The small government provides many resources and this information is av ailable to all constituents on the web or even at the county office. However, t here are many citizens who do not have access to the web. They may be unable to travel to the county office or health department to obtain this information bec ause they lack transportation. These citizens may only get information via TV n ews reports but these occur immediately prior to the approaching storm. This ma y not leave the citizen with enough time to get prepared or to be educated on ho w they can protect themselves. I feel that the county does a good job of preparing for a potential disaster but needs to go further to reach the part of the public that is most at risk for se rious health issues and/or injury if this type of event were to occur.

Time Line solicit community involvement from private and public entitys to create a December nd plan a system to provide for the under-privileged that are sometimes ill-equi pped to deal with a natural disaster. January Conduct meetings of all focus groups to creat the plan. February Organize drives to solicit donations for survival kits, confirm plans put in place to educate the public March Use volunteer groups to assimilate the survival kits including information p ackets specific to the type of disaster such as hurricane, tornado, and/or flood ing. April Use mass distribution to distribute the survival kits as well as the informa tion packets. Hold community meetings providing education to members of the cou nty. May Continue to provide education including answering any questions that arise fro m the private and public groups as well as the public. December (after new implementation) Focus groups, review and determine did the pla n work. If not, what should be changed?

Nassau County, Florida. (n.d.). Retrieved from http://www.city-data.com/county/N assau_County-FL.html Nassau County Emergency Preparedness. Retrieved from http://www.nassaucountyfl. com/index.aspx?nid=97 National Weather Service Hurricane Center. Retrieved from http://www.nhc.noaa.g ov/ Schleifstein, M. (2010). The Times-Picayune. Retrieved from http://www.nola.com/hurricane/index.ssf/2010/02/emergency_evacuation_challenge.h tml University of Minnesota. Public Health Interventions. Retrieved fromhttps://cph eo1.sph.umn.edu/MCLPH/InterventionWheel/ Nassau county, florida:. (n.d.). Retrieved from http://factfinder2.census.gov/fa ces/nav/jsf/pages/searchresults.xhtml Health Needs Assessment. Retrieved from http://www.hpcnef.org/files/health-needs -assesments/NassauCountyHNA.pdf Healthy People 2020. Retrieved from http://www.nefloridacounts.org/index.php?mo dule=Trackers&func=display&tid=1 Nassau County. Retrieved from http://tpeg.med.miami.edu/documents/Nassau2008.pd f