By Susan Eckert, RN, MSN THE SEVERE ACUTE respiratory syndrome (SARS) epidemic of 2003 and 2004...the tsunami that devastated Southeast Asia in 2004...the London transit bombings and Hurricane Katrina in 2005. Major disasters can kill, injure, and displace tens of thousands of people. As healthcare providers, we play a central role in dealing with disasters. With so much at stake, nurses need to learn as much as we can about preparing for and managing emergencies. To increase your confidence in working through a disaster, here’s advice I’ve collected from colleagues who’ve “been there, done that.” Know how to communicate Imagine this scenario: You’re working your shift at the hospital when the telephones suddenly go dead. A few moments later, the electronic displays and overhead lights flicker, 34 American Nurse Today October 2006 Registered nurse Dwayne Howerton tends to one of the more than 3,000 patients treated at the field hospital on Louisiana State University’s campus during Hurricane Katrina. and you hear the emergency generator kick in. What’s going through your mind? You may wonder whether the outage is affecting just your area, the entire building, or the whole community. You may worry about loved ones. Are they safe? How will you reach them? Of course, you’d be concerned for your patients. Did they notice the lights flicker? Do they know the phones aren’t working? If so, are they panicking or staying fairly calm? More important—is critical patient care equipment still running? How will you be able to communicate with the resource personnel you need to provide safe care? Prompt, clear, reliable communi- Photo: Jim Zietz, LSU Public Affairs How to plan for the unthinkable cation is vital to healthcare facilities at all times—but it’s absolutely critical during an emergency. The Joint Commission on Accreditation of Healthcare Organizations requires healthcare facilities to have backup internal and external communication systems in case the primary system fails. Before an emergency occurs, learn about your facility’s backup system. Are backup telephones available on a different telephone switch? If so, where are they located? Do you know how to use them? Or maybe your facility has purchased portable radios or satellite phones to use in case of emergency. Do you know where to find them and how to use them? Even if the telephones are down, you might still be able to use the Internet and e-mail, depending on the type of connection your facility has. In the first few days after Hurricane Katrina, e-mail proved to be one of the most reliable communication methods. Protect yourself If you’re not safe, your patients won’t be safe. The SARS experience taught us many hard lessons. Nurses and other healthcare providers became infected with the coronavirus that causes SARS, and died before they recognized the need to use appropriate protection—particularly during high-risk respiratory procedures. Would you know how to protect yourself if your facility received SARS patients or victims of chemical or radiation contamination? Frontline workers—including “first receivers” and the staffs of emergency departments, trauma centers, and operating rooms—may face especially significant risk in these situations. If you’re a front-line worker or if you’re on your unit awaiting patients from a mass casualty incident, first find out if you’re at risk from contact with victims. If the answer is “yes”—or if no one seems to know—assume the worst and don appropriate personal protective equipment (PPE), according to facility policy. Depending on the situation, for instance, you may need to wear an N-95 mask or full protective gear with powered air-purifying respirators. Better yet—don’t wait until a disaster occurs to get up to speed. Before disaster strikes, find out what precautions to take by asking people in your organization who’ve worked on these issues. Get answers to the following questions: • How would we transport contagious or contaminated patients to the operating room, diagnostic imaging area, or other key areas? • How would we handle patient waste and potentially contaminated linens? • How would we send patient specimens to the lab? • What would we do if an infected patient “codes”? • What actions, if any, would we perform differently than usual for these patients? Recognizing that these situations put healthcare workers at risk, the U.S. Occupational Safety and Health Administration (OSHA) has published guidelines titled “OSHA Best Practices for Hospital-Based First Receivers from Mass Casualty Incidents Involving the Release of Hazardous Substances.” To view this document, visit www.osha.gov/dts/osta/bestpractices/html/ hospital_firstreceivers.html. Another resource for healthcare workers is the ER One Institute in Washington, D.C.—a national testbed for responding to both conventional and nonconventional medical threats. (See Inside the ER One Institute.) MAGNET® STATUS – NURSING’S HIGHEST HONOR VCU Health System congratulates its entire nursing staff on achieving a rare distinction: Magnet status. This designation is nursing’s top honor – the “gold standard” in nursing excellence. Nurses are key to quality health care – that’s why the Magnet Recognition Program was developed by the American Nurses Credentialing Center to recognize health care organizations providing the very best in nursing care. Protect your patients Learn about the basic steps you need to take to ensure patient safety. For instance, how would you evacuate your part of the hospital, if required? If you’re not sure, read up on your facility’s evacuation plan. Chances are, you don’t need to know the full scope of the plan. But at least find out where you and your patients should go if you need to move from your location immediately. Many facilities have equipment to assist in evacuation, especially for nonambulatory patients. Know what equipment is available and how to get it—at any hour and any day of the week. If the disaster doesn’t require evacuation and you’re preparing to receive victims, here are some steps you can take to safeguard your patients, no matter which department you work in: • Prepare for a rapid surge in patient influx. Initially, expect large numbers of victims to arrive at the hospital rapidly. To estimate the total number of victims who are likely to come to the facility, disaster planners typically double the number of victims received during the first hour. However, if you’ve Richmond, VA's ONLY MAGNET HEALTH SYSTEM IT’S ALL ABOUT EXCELLENCE When U.S. News & World Report publishes its annual ranking of “America’s Best Hospitals,” facilities with Magnet status score among the highest in nearly every category. Using vigorous standards, the report ranks more than 6,000 hospitals in 17 specialties. Of 14 hospitals singled out as Honor Roll Centers – those that excelled in six or more specialties – four of the top five have achieved Magnet status. OUR PATIENTS ARE WINNERS TOO In addition to attracting extraordinary nurses, Magnet facilities offer many patient benefits – better patient outcomes, increased time spent at the bedside, shorter lengths of stay and lower patient mortality rates. Magnet status – good for nurses, good for patients. It’s a winning combination. vcuhealth.org October 2006 American Nurse Today 35 Inside the ER One Institute Located in Washington, D.C., the ER One Institute is a federal initiative committed to research, development, training, and implementation of next-generation emergency preparedness facilities and processes for hospitals and healthcare providers. Housed at the Washington Hospital Center, the major receiving hospital in the region, it relies on cutting-edge education and information management tools to provide the best information on emergency preparedness topics. The Institute is led by an expert team of disaster preparedness educators and healthcare professionals and employs nurses, physicians, and midlevel practitioners. Staff nurses play a key role in implementing the Institute’s mission. With their knowledge of hospital systems, the clinical needs of victims of mass casualty incidents, and educational principles, nurses have been active in developing and testing systems and approaches that enhance a hospital’s capability to respond to a disaster successfully. Expertise on offer To adequately prepare hospitals for the looming but realistic threats of today, the Institute provides expertise in meeting the challenges faced by today’s healthcare workforce, including: • complying with requirements of the Joint Commission on Accreditation of Healthcare Organizations, Occupational Safety and Health Administration, and National Incident Management System • designing comprehensive emergency preparedness plans for internal and external emergencies • determining what personal protective equipment, stockpiles, and other response equipment are needed • training hospital staff for emergency preparedness management, practices, and procedures • designing and organizing disaster exercises. For more information, visit www.er1.org. obtained statistics from the scene itself, from media reports, or from the local Emergency Operations Center, use these in36 American Nurse Today October 2006 stead of the general “doubling” rule. • While wearing appropriate PPE, assess arriving patients and focus on the actions you and your team members must take to move previously admitted patients to other destinations, if needed. In case you need to accept new victims, collect patients’ laboratory results, administer ordered medications, complete ordered treatments, and organize medical equipment and personal belongings so you can transfer these patients rapidly. • Help your facility collect the information it needs to obtain a bed count, capacity count, and staff count. These numbers will help officials determine what resources are available to respond to the emergency. Know who’s in charge Although consensus decision-making can be a wonderful tool for nurses, a disaster isn’t the right time to use it. Time and again, those who’ve worked through disasters emphasize that a single person (preferably predesignated) must take charge, assuming the role of formal leader and guiding the staff accordingly. This person should be your most experienced and competent nurse. In your organization, it could be a charge nurse or nurse-manager. This person organizes efforts within the department (such as promoting patient flow and providing bed, staff, and equipment counts) and interfaces with the system. Be aware that all hospitals are required to have an incident command structure or system to respond to emergency events. A common command structure is the Hospital Emergency Incident Command System, which organizes hospital personnel into leadership and functional roles that facilitate the response to an emergency. Know the system your organization uses, and learn with whom you should interface during an emergency. Cooperate and collaborate In a disaster, all staff members must cooperate and collaborate with other departments to ensure that the facility responds rapidly and effectively. Ideally, the facility’s response should be integrated with the response of the community as a whole. During a disaster, you may be designated to report to a labor or personnel pool. Most likely, you’ll stay in your department or be asked to respond from home to assist in patient care. Do your best to ensure that patients are tracked in the system carefully so that family and friends know their location and status. As requested, provide accurate information to your facility’s public relations department so it can send an accurate, consistent message to the community—which, in turn, reduces undue stress caused by misinformation. Care for the caregivers Like everyone else, healthcare providers need care during an emergency. Your facility should have plans in place to meet staff members’ basic needs. Unfortunately, “just-in-time” inventories and space crunches have gradually whittled away many hospitals’ stockpiles of emergency supplies. Hurricane Katrina showed all too clearly what can happen when dedicated emergency supplies are in short supply. Caregivers frequently were unable to bathe; lacked nutritious food, clean linens, and hygiene products; and were forced to conserve water. Conventional wisdom and emergency planners may recommend keeping on hand enough essential supplies—including food, water, electrical power sources, patient supplies, and waste systems—to last 3 days. But Katrina showed us that a 3-day supply may not be adequate. You may need enough to last for 5 or even 7 days. Sometimes, caregivers’ need for COMMITTED TO YOU AND YOUR CAREER emotional support is overlooked. Nurses should have access to outlets for sharing and discussing their experiences. Debriefing sessions from events such as the Rhode Island nightclub fire of 2003, which killed 99 people and sent 200 more to hospitals, pointed to the impact on caregivers both immediately after the event and months later. Each healthcare organization’s emergency plan should provide for both individual counseling services and formal groups facilitated by mental health professionals. Plan for disasters at home Effective planning also helps you and your family prepare for disasters. Here are some important steps you can take at home: • Establish an emergency plan for you and your loved ones. Make sure everyone understands the plan. • Gather basic emergency supplies in your home. • Write down important contact information and distribute it to all family members. • Designate specific meeting points outside the home where family members can reunite if separated. It can happen to you Few people expect—and no one wants—to be involved in a disaster. But you may find yourself in the middle of one at any time. Emergency planners emphasize that to stay prepared, you should assume it’s not a matter of if but when a disaster will strike. As a nurse, your role in providing care is even more crucial during an emergency. You’ll be called on to use all your skills under stressful circumstances. But isn’t that what nurses do every day? Nurses are extraordinarily resourceful and creative. Adding emergency preparedness to your knowledge base can greatly enhance the power of your practice—and can help you save ✯ lives when the unimaginable happens. Selected references Agency for Healthcare Research and Quality. www.ahrq.gov/prep. Accessed July 21, 2006. Emergency Nurses Association. www.ena.org/EmergencyPrepared. Accessed July 21, 2006. Federal Emergency Preparedness Agency. www.fema.gov. Accessed June 29, 2006. Joint Commission on Accreditation of Healthcare Organizations. www .jointcommission.org/PublicPolicy/ep_home.htm. Accessed June 29, 2006. Koenig KL. Strip and shower: the duck and cover for the 21st century. Ann Emerg Med. 2003:42(3):391-394. Loeb M, McGeer A, Henry B, et al. SARS among critical care nurses, Toronto. Emerg Infect Dis. 2004;10(2):251-257. Occupational Safety and Health Agency. www.osha.gov. Accessed June 29, 2006. Susan Eckert RN, MSN, is Director of the Institute for Innovations in Nursing Readiness at the ER One Institute, Washington Hospital Center, Washington, D.C. look forward Join St. Mary’s Hospital, one of the most distinguished healthcare facilities in Colorado. Currently, we are seeking qualified nurses to join our team in these full time and PRN positions: RN OPENINGS: L&D, SURGICAL, CATH LAB, ICU, MED/SURG, NEPHROLOGY CLINIC, WELL NURSERY CLINICAL MANAGER(S) - PeriOp and Intensive Care www.stmarygj.org 2635 North 7th Street Grand Junction, CO 81501 970-244-7194 fax [email protected] Call us at 1-800-458-3888 EOE / Drug-Free Workplace Career possibilities:The more you have, the better.We invite you to excel with a not-for-profit hospital that is implicitly patient focused.You will share the excellence of a regional Level II Trauma Center.Your career choices will span a full range of clinical services that rank us among the top 5% of America’s hospitals.You will also join a leader that has affiliations with the National Institutes of Health (NIH) and Johns Hopkins Medicine, and a ground-breaking Cardiac Surgery program. Suburban Hospital is ranked #1 in the country for Overall Employee Satisfaction according to a recent survey conducted by The Jackson Organization, the national healthcare research, survey and consulting company. Begin exploring the possibilities today. Experienced Staff RNs OR • ED • ICU • Med/Surg • CTU• CVOR • Cardiology • Radiology We offer excellent benefits including very attractive incentive programs, bonus plans, scholarship programs, critical care differentials, relocation assistance, competitive salaries and much more. Please apply online at: www.suburbanhospital.org; E-mail: [email protected], or send resume to Suburban Hospital, Attn.: Human Resources, 8600 Old Georgetown Rd., Bethesda, MD 20814, Fax: (301) 897-1339, Phone: (301) 896-2067. EOE, M/F/D/V. We perform pre-employment drug/alcohol screening. www.suburbanhospital.org Recently recognized as one of Washington’s Best Hospitals by Washingtonian magazine. October 2006 American Nurse Today 37