Dan Nadworny, MSN, RN, Point Person for the 2013 Boston Marathon Bombing

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    Mass Casualty Incident - even the words sound impressive. The reality can be overwhelming, chaotic, unnerving and just plain frightening. How do you continue to cope during a disaster? How do you even think what to do next?

    Dan Nadworny, MSN, RN, Point Person for the 2013 Boston Marathon Bombing

    AllNurses staff recently interviewed Dan Nadworny, MSN, RN, Clinical Director for Operations at Beth Israel Deaconess Medical Center in Boston, MA. He was the point person during the Boston Marathon Bombing in April 2013. He will also be one of the featured speakers at the Emergency Nursing 2017 conference to be held September 13-16 in St Louis, MO where he will conduct a mock disaster drill, emphasizing hands-on teaching.

    In the interview we discussed training for Mass Casualty Incidents (MCI) as a means to prepare for the unknown. Dan stated, “disasters are local.” When an MCI occurs the resources that you have immediately on hand are the ones you will immediately use. As time goes on, more resources might be available but it is important to be able to rely on immediate staff to make the most impact on survivability. As the basics get dealt with, you continue to move forward to the more complex tasks. A cohesive staff is a must for any emergency department and it is of paramount importance during an MCI. “Disasters will occur,” Dan said and relying on your training will enable you and your team to come through with the best patient outcomes.

    He went on to discuss what training involves. Although slide presentations have their place in training situations for routine matters, nothing beats hands-on and “real life” training. We discussed off-site training for ED staff incorporating local fire departments. Dan emphasized that it’s important to spend time working with other agencies because in an MCI, other agencies will be involved and having a working relationship allows all stakeholders to conquer a disaster. Some of the important details to discuss with other agencies include:

    • Communication - operating on same radio frequency, what to do if no cell service or no landlines
    • Organization and leadership structure - who is going to be the “Captain of the Ship?” Does it make sense for the ED Attending MD who is not “on the streets” or should the police take the lead or the fire department?
    • Where is equipment stored? Does everyone know how and when to don it? This was brought home vividly during the Ebola crisis.

    Dan had several suggestions:

    • Hands on demonstrations of equipment, personal protective equipment (PPE)
    • Working for a prolonged period of time in a hazmat suit - how do you start an IV, obtain an EKG, even talk to the patient
    • Training with other agencies on their turf. Getting out of your comfort zone.

    With all the training modalities available, it is hoped that you won’t experience an MCI. However, if you find yourself in the middle of a disaster, your training will be what saves you and your patient. During a disaster, many people report time stands still. As the adrenaline kicks in, you respond as your training dictates.

    Once the MCI resolves though, an even longer period of time occurs - recovery. Peer discussions are often a focal point for emergency workers who have been thru a traumatic event. Sharing details and retelling them allows for shared grief and shared healing. Dan stated that there is no one “right” way to recover. While some workers internalize their emotions, others seek relief from a support group, either formal or informal, a professional counselor or a member of the clergy.

    Anniversaries of MCI’s are a cause for strong emotions also. From sadness, grief, fear to anxiety and dread people involved in an MCI run the gamut. Dan also commented on this aspect of the MCI during an interview in 2014 with WGBH in Boston, "I think I have a greater respect for how a hospital works together than I ever did," he said. "And I think that did change me — for the better. And I think it will always be a little bit different, but in my mind, the differences need to be looked at as a positive. We now know what we can accomplish together and this hospital knows what it can accomplish together."

    Dan authored an article in the Emergency Nurses Association Journal of Emergency Nursing in 2014 and commented, “The importance of community and individual hospital preparedness for mass casualty events has become increasingly apparent as the magnitude and frequency of natural and humanmade disasters has escalated in recent years. Beyond the formal after-action reports, sharing experiences and lessons learned with others after an event allows for learning through a whole new perspective.”

    Come to Emergency Nursing 2017 for hands-on training from an expert in mass casualty incidents! Early Bird Registration ends July 13th.

    Non-ENA members who register by July 13 can use the promo code: STLOUIS for $100 off conference registration.

    And for more details.....here you go....

    References:

    Beth Israel, One Year Ago

    Boston Strong - One Hospital’s Response to the 2013 Boston Marathon Bombing

    Emergency Nursing 2017
    Last edit by traumaRUs on Aug 8
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  3. by   traumaRUs
    Thanks so much for all this insight.

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