cation is vital to healthcare facilities

By Susan Eckert, RN, MSN
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,
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
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
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
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
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.
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.
October 2006
American Nurse Today
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
For more information, visit
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”
• 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
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.
Accessed July 21, 2006.
Emergency Nurses Association.
Accessed July 21, 2006.
Federal Emergency Preparedness Agency. Accessed
June 29, 2006.
Joint Commission on Accreditation of Healthcare Organizations. www 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. 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
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October 2006
American Nurse Today