Mention emergency preparedness and nurses immediately think 9/11 or Katrina and the after-the-fact scrambling to define and shore up a defense infrastructure.
“The Homeland Security Act of 2002 that mobilized the nation to secure the country from future terrorist attack focused on prevention, preparation, and response,” says Nina Goossens, RN, MS, manager, Public Health Programs, Visiting Nurse Association of Central Jersey.
On the local level, nurses must give attention to these aspects of emergency preparedness in all types of catastrophes — hurricanes, chemical spills, power outages, and epidemics — that happen right in their own backyards. Local nurses prepare by getting involved in their institutions, agencies, or communities, Goossens adds.
In Real Time
Last year, a major evening power outage in several areas of Monmouth County that included some of the VNACJ service areas tested the agency’s emergency preparedness. By using a roster that identified priority patients, such as those on oxygen and ventilators, a nurse manager and senior managers confirmed that all clients and staff were safe. The roster also contained the locations of the after-hours staff on duty.
“Having available the most current information about patients and staff and making sure that communication by phone and/or computer is facilitated are vital to the response process,” Goossens says. In post-evaluation, there is always room for making the system better; for example, by revamping the phone chain or adding more people to it, she adds.
“We’ve learned from experience what our needs are,” says Sandra Van Sant, RN, APN, MPH, health officer, Monmouth County Regional Health Commission, Ocean Township. After Katrina, several nursing homes in central New Jersey discovered they had contracted for ambulance evacuation services with the same company, leaving all of them at risk of having no means for evacuating patients. As a result, each nursing home now has contracted for dedicated ambulances to their facilities in the event of emergency.
Nurses in ActionNina Goossens, RN
Emergency preparedness knowledge must filter down to the staff nurse, says Van Sant. Nurses should know their facilities’ emergency plans and what their expectations of staff are. Nurses must also have personal plans to alleviate worry about their families while they are working during an emergency and should encourage others to develop their own personal plans.
“All of us need to be educators about disaster planning,” says Goossens. School nurses can teach families and faculty about emergency preparedness, and home care nurses should discuss emergency planning with patients and families, like the specifics for emergency evacuation.
Van Sant advises nurses to tell the public about the N. J. Register Ready, a supplementary plan for those in need of evacuation services in the event of disaster. This Web site (www.deltafour.com/NewJerseySNS) allows residents with special needs and their families, friends, and associates the opportunity to provide information to emergency response agencies. With this information, emergency responders can make better plans to serve registrants during an emergency. Individuals who cannot drive, are on oxygen, have mobility concerns or have dementia, for example, can register or have their loved ones register them online, or by calling 211, as back-ups to their personal emergency evacuation plans.
“What may seem like small things are so important during emergencies,” says Goossens. She recommends, for example, that nurses review donning and removing personal protective equipment prior to a hazardous biological event.
Locally, nurses can become involved by joining their institutions’ emergency preparedness committees, attending regular meetings and volunteering to work on subcommittees. Nurses can also join the Medical Reserve Corps established at their local health departments or on the state level.
Learn More at NJSNA
In March, at the NJSNA convention held in Atlantic City, Goossens and Van Sant will provide an interactive session about emergency preparedness. Through dialogue, nurses from different disciplines will take the generic concepts and apply them to varied nursing roles, using different scenarios and approaches to handle various emergencies. “The aim is to get nurses to think about their practice sites and the policies in place, identify any gaps that might exist, and prepare locally for any disaster,” Goossens says.
Coordination and CollaborationSandra Van Sant, RN
“More than ever before, New Jersey has been working closely with the county and local Offices of Emergency Management, Public Health, and healthcare facilities on emergency preparedness,” says Van Sant. Coordination and collaboration with the larger grand plan on the national level is crucial.
On the state level, the N.J. Office of Emergency Management promotes prevention of and preparation for disasters through the Medical Coordination Center in different regions. Here representatives from hospitals, home care, primary care centers, and long-term care plan how to coordinate resources in the event of disaster. Should a hospital fire break out in Monmouth County, for example, institutions in other counties can provide needed resources. The state allocates federally funded grants for emergency preparedness for equipment and funds to perform drills and tabletop exercises on the state, regional, and local levels.
At the VNACJ, where Goossens serves as chairwoman of the Emergency Preparedness Committee, members meet routinely to address patient coordination and collaboration with other community agencies, including county and local health departments, the Office of Emergency Management, and other healthcare facilities.
“The VNACJ has worked for nearly 100 years to maintain quality patient care and staff safety during disasters. Since 9/11, collaboration with the community has increased as we plan and carry out disaster drills within the community,” Goossens says.
How Key Players Operate
Job titles coined by the federal government filter down to and are adapted on the local level in times of calamity.
The incident commander within an institution or agency, for example, refers to an individual at the senior management level who makes all decisions, authorizes the release of information to the press, and manages the incident response. This individual would, however, defer to the county health officer as ultimately in charge during a biological insult.
Goossens describes other command roles as they apply to healthcare institutions or agencies. Designated planners collect and evaluate patient information and distribute it to the appropriate people to provide needed care. Those in Operations, typically top managers, direct and coordinate operations and assist the incident commander to develop and implement goals. Those in Logistics, usually members of the IT and facilities’ management departments, provide resources, facilities, services, and supplies.
The N.J. Register Ready can be found at: www.deltafour.com/NewJerseySNS.