Emergency preparedness in early 2001 focused on what nurses and hospital staff considered possible — fires, plane crashes, hurricanes and flooding.
But the definition of what was possible changed with the Sept. 11, 2001, terrorist attacks.
“Sept. 11 basically raised the red flag,” said Martin Camacho, ACNP-BC, MSN, of the department of emergency medicine at the Hospital of the University of Pennsylvania in Philadelphia. “The world we knew at that time had completely changed.”
The attacks forced hospitals and their staffs to prepare for events “that could be much bigger and much badder” than previously considered, said Thomas Grace, RN, BSN, PhD, vice president of health services and emergency preparedness at the Delaware Valley Healthcare Council of the Hospital & Healthsystem Association of Pennsylvania.
In the 10 years since the attacks, nurses and hospitals have taken emergency preparedness to a new level and incorporated other hospitals and the community in their planning.
“It’s a major milestone we’re reaching,” Grace said.Thomas Grace, RN
Pre-Sept. 11 preparedness
Before the terrorist attacks, emergency preparedness occurred within the walls of individual hospitals and mostly in EDs, Grace said. “The silo approach to disaster planning was institution- or facility-based planning,” he said.
Hospitals concentrated on how they would handle patients who came to their facilities in emergencies and any messages that needed to go out would be sent by fax, Grace said. “None of us could talk to each other.”
Because of a “wide degree of complacency,” emergency preparedness drills were not done effectively, Camacho said.
“Before Sept. 11, we were comfortable,” Grace said.
Attacks motivate staff to prepare
The mass casualties from the 9/11 attacks prompted new emergency preparedness initiatives, Camacho said. The possibility of such events “became real, and people became motivated at every level” to prepare, Grace said.
Nurses played an integral part because of their experience directing patient flow in EDs, ICUs and other areas of the hospital and ensuring the safety of patients and the facility, Camacho said.
In the wake of the attacks, nursing and hospital administrative leadership reviewed emergency preparedness plans and found areas that needed to be addressed, according to Grace. For example, biological and chemical attacks became a concern.
Leaders realized that communication among hospitals would be essential.
“We recognized we had to work together to be able to respond sufficiently to something that was bigger than what we could imagine,” Grace said. “That’s a significant change.”
Communication systems now allow hospital emergency management centers to announce problems to a county emergency center, which shares the information with other hospitals, ambulances and providers, Grace said. One hospital used the system recently when phone service was disrupted. Within two minutes, the county’s emergency manager contacted the hospital to confirm the outage and within five minutes had told ambulances to use radios to communicate with the hospital.
The systems also can text other providers about problems or emergencies, Grace said. “We don’t need to go down a phone chain that takes an hour to get to the hospital and the right person,” he added.
Drills have become more frequent and elaborate. At HUP, staff perform thorough emergency preparedness drills at least twice a year, Camacho said. Drills include setting up decontamination tents, staging scenarios that include staff donning protective equipment and conducting decontamination exercises. Those types of drills were not done before the terrorist attacks.
“Now we actively engage in those things,” he said.
Efforts to prepare continue
Nurses play a key role in spearheading efforts to educate the public and work with lawmakers to determine how resources should be allocated, Camacho said. He urged his colleagues to work to bridge the gap between front-line nurses and policymakers.
His colleagues also can work with staff at their facilities to avoid complacency with drills, he said.
For example, nurses can meet at lunch or shift changes for 10 minutes to work through emergency scenarios and determine what they’ll do in those situations, such as to meet at a certain stairwell, Grace said.
“If they’ve worked through it as a team and something happens, it’s a reflex instead of a thought,” he said. •
Karen Long is a freelance writer.