<Given the nursing shortage, in the event of a national disaster, will enough nurses respond to effectively meet the need?>
This is another aspect of the nursing crisis that no one but nurses ever thought of before & didnt listen to nurses arguments on. After Sept 11, 2001, the powers that be got a rude awakening. Now the nursing shortage has taken on a more serious meaning for them. The fact that there may not be enough nurses to respond to a national disaster or attack is underscoring our efforts in state legislatures & in DC. In the meantime, in NY, efforts are being made to effectively train the ones we do have:
Bioterrorism - Are Nurses Prepared?
by Nancy Webber
New York State Nurses Association
In a recent episode of the popular TV show, "ER", the staff of the world's most famous emergency department was faced with two suspected cases of smallpox.
What followed was confusion: physicians searching through old CDC posters to identify symptoms, uncertainty about isolation procedures, and a climactic moment when quarantined patients in the ER tried to break down the doors.
Would New York hospitals be thrown into such a panic? After Sept. 11, it's less likely. Healthcare providers at every level have been working hard to prepare for the unthinkable - an attack in which infectious agents are used as weapons.
Hospitals develop emergency plans
In a letter to hospital CEOs this spring, the state Department of Health urged all facilities in the state to develop plans for responding to bioterrorism and to share them with local public health departments. Hospital emergency rooms are to closely observe incoming patients and identify disease clusters in order to quickly identify bioterrorist attacks.
"There's been a lot of activity since the fall," says Kristine Gebbie, director of the Center for Health Policy at the Columbia University School of Nursing. "A lot of money is going into training and increasing the basic level of knowledge about likely agents used in bioterrorism."
In late May, the U.S. House of Representatives voted to spend $4.6 billion over the next two years to help hospitals prepare for bioterrorism and to build stockpiles of vaccines. It includes education programs for emergency medical personnel.
Gebbie, a registered nurse, has been speaking before nursing groups about her research into what healthcare workers need to know for emergency preparedness. She hopes to expand this work into developing core competencies in bioterrorism for public health workers.
Across the state, hospitals are updating emergency plans, upgrading facilities and equipment, and filling in their staff's educational gaps. A database has been developed by the New York City Department of Health to identify fever clusters among emergency room cases, which can be early warnings of a bioterrorism event. The state DOH is now working to implement this system beyond the city.
A crash course in the unthinkable
Peter Allar, a nurse educator in the emergency department at St. Vincents Medical Center in Manhattan, is responsible for training and updating staff on responding to bioterrorism. They had a lot to learn. "Before Sept. 11, there was one decontamination shower near the emergency department, but no one knew where it was or how to use it," he said. "Now there are four permanent showers and more that can be set up quickly if needed."
Allar has created a four-hour course that he has presented to the nursing staff and to "anyone associated with the hospital," including volunteers. He plans future training with the hospital's community health staff.
Like most healthcare providers, Allar knew very little about bioterrorism before Sept. 11. Since then, he's given himself a crash course, attending a two-day training in hazardous materials and reading all the articles and books he can get his hands on.
If there is an outbreak of anthrax or smallpox, the first cases will come through the ER. Allar reminds emergency nurses of their crucial role in recognizing the symptoms and preventing further infection. "You can be the nurse that lets someone in and infects everyone because of what you don't know," he says, "or you can be the nurse who has the information and saves New York City."
During the training, Allar provides an overview of materials that have been used as weapons before and could possibly be used again: toxic chemicals, infectious agents, nerve gas, cyanide. He gives everyone a chance to put on an OSHA suit and to operate the hospital's decontamination showers.
It's a grim subject, but the key to Allar's message is that nurses are not helpless in the event of a terrorist attack.
"The first thought is, 'We're all doomed - it will be the end of life,'" he said. "But if something happens, we can do a lot to keep people alive and bring people back." St. Vincents now has 300 anti-cyanide kits and will soon have anti-nerve agent kits as well.
Meg Barry, a nurse educator at Columbia-Presbyterian Medical Center, has been giving Grand Rounds presentations to nurses on bioterrorism preparedness. She believes that training will have to be continuously updated.
"Recently I saw an article about the Indian Point nuclear plant and the evacuation plan in case of an incident there," she said. "Depending on which way the wind is blowing, radiation could affect 2 million people. We need to be trained in responding to radiological emergencies as well."
Hospitals are also focusing more on security. Many facilities have restricted access as never before. At Columbia Presbyterian, access to the hospital's air and water systems is locked. Plans are now in place to keep the hospital from becoming contaminated in a bioterrorism emergency.
Learning from the Israelis
Nurses involved in bioterrorism training recognize that the programs must be continually updated. A long-term commitment of time and money is necessary. And there must be an ongoing effort to improve coordination and communication among various health and emergency agencies.
Jacqueline Merrill, a nurse researcher at Columbia, traveled to Israel in December 2001 to observe emergency preparedness there. She found a society where disaster response has been honed to an exact science. "Their state of readiness is far superior to ours because their level of threat is so much higher," she said.
Israel is roughly the size of New Jersey, with 24 hospitals in the entire country. Its Home Preparedness Branch is responsible for ensuring that health personnel, police, fire, and the military work together in the event of a terrorist attack. Merrill observed two emergency drills during her visit, one announced and one unannounced, that involved upwards of 1,000 people.
The Israelis have done a lot of research into how the public will respond in an emergency. According to Merrill, 70% of the population can be expected not to panic. "People will behave rationally if they are given the right tools in terms of guidance and resources," she said. "Information provided without clear, specific guidelines for action can cause anxiety."
Emergency response in the U.S. will be much more difficult to organize, because of the multiple levels of government agencies and a less homogeneous society. But the continuing threat of terrorism makes cooperation essential. And there is no doubt that emergency nurses and public health nurses will be on the front lines.
The researchers at Columbia have found that, during an emergency, the importance of various nursing skills is inverted. Usually, a nurse needs a wide range of clinical skills and uses relatively little managerial ability, as most of that is taken care of by the hospital structure. In an emergency, a nurse's organizational skills become paramount while the range of clinical skills required may be limited to a few basic treatments.
"We need to find out what we don't know," said Gebbie. "We need to find out what it will take to keep training fresh. It's going to take time, and staff time in hospitals is budgeted down to the last millisecond. But without this commitment, we won't have the kind of prepared work force we're going to need."
NYSNA has an online course entitled "Biological Agent Exposure: What RNs Need to Know" available at www.nysna.org. The cost is $10 for NYSNA members and $12.50 for nonmembers. Log on and learn today!
Bioterrorism Rapid Response Card
The New York State Department of Health has developed a Bioterrorism Rapid Response Card that folds to pocket size. It contains guidelines on recognizing bioterrorism-related illnesses, phone numbers for reporting suspicious illnesses or disease clusters, and the symptoms and treatments for the most common biologic agents, including anthrax, smallpox, and viral hemorrhagic fevers.
One copy of the card is available free of charge to NYSNA members. To order, members may call the NYSNA Practice and Governmental Affairs Program at 800.724.NYRN, Ext. 282 or e-mail. Make sure to include your mailing address. Non-members may call the NYS Department of Health.