On April 15, two bombs were detonated at the Boston Marathon. On April 17, an explosion at a fertilizer plant rocked the small town of West, Texas. A month later, on May 15, tornadoes wreaked havoc across towns in north Texas. Twisters again caused enormous damage when they blew threw the Oklahoma City area May 19, destroying entire neighborhoods, including an elementary school and a hospital.
Since the Sept. 11, 2001, terrorist attacks, the possibility of mass casualty incidents has become very real. Hospitals and other healthcare facilities do their best to get ready for disasters, creating emergency preparedness plans and holding drills to assess and fine-tune responses.
But what happens when nurses are out of a controlled environment like a hospital and instead are at the scene of an unexpected disaster?
Nurses with military training or trauma-care experience may feel comfortable handling mass casualty events, but not all nurses have such backgrounds. What should they do if they find themselves in a disaster situation?
Be prepared
After the Sept. 11 attacks, "when the war was brought home to the community, to the neighborhoods, a lot of people [in nursing education] realized that all nurses, not just ED nurses [and] military nurses, need to be trained in disaster competencies," said Marilyn M. Pattillo, RN, PhD, GNP-BC, CNS-BC, FAAN, associate professor of clinical nursing at the University of Texas at Austin School of Nursing.
Pattillo developed and taught two disaster nursing courses and later integrated disaster nursing competencies throughout the nursing school?s curriculum. However, the program is the exception in nursing education, not the rule.
Most nurses are required by their employers to keep current a basic life-support certification, which covers CPR but not first-aid skills, and may not be sufficient to prepare for emergencies, according to emergency-preparedness experts interviewed by Nurse.com.
One of the most important things nurses can do to prepare for any kind of "no-notice event" is to get first-aid training, according to Mary Casey-Lockyer, RN, BSN, MHS, CCRN, disaster health services manager for the American Red Cross.
"In nursing education, first aid is not taught, so there is a lot of skill level, a lot of knowledge, but not a basic first-aid curriculum," she said. Nurses can contact their local branch of the American Red Cross to find out how to get trained in first aid.
Casey-Lockyer knows from experience how hard it is for a healthcare professional to be in an emergency without the regular tools. "You have to be prepared to act quickly without all the bells and whistles and the technology that we have in our inpatient setting," she said. "You have to be able to do what you can with nothing."
Years ago, Casey-Lockyer came upon a car accident in which the person was alert and a pinned arm was completely degloved, with skin and muscle torn away from bone.
"It was a horrible feeling because there was nothing — no stethoscope, no blood pressure cuff, no IV fluids," she said.
To be prepared for an emergency, nurses should keep a ready-made emergency bag in their car, with CPR mask, gloves, water and materials to make a tourniquet, said Pattillo, who also keeps extra shoes and clothes in her car.
The ABCs
Every expert who spoke with Nurse.com named the ABCs of nursing assessment: airway, breathing, circulation — or, alternatively, airway, breathing, compressions — as the first things nurses should attend to in an emergency.
"It?s about situational awareness and using what is in your environment, making it work to support the ABCs until more help is there," said Maryfran Hughes, RN, MSN, nursing director, emergency services at Massachusetts General Hospital in Boston. "[At the Boston Marathon,] first responders with no medical training were using the belts they were wearing to tourniquet wounds. People were getting T-shirts from [a clothing] store and ripping them and using them as tourniquets."
For nurses at the scene like Betty Sparks, RN, CNOR, an OR nurse at Newton-Wellesley Hospital in Newton, Mass., and an eight-year veteran volunteer for the Boston Athletic Association who was working at the finish-line medical tent when the bombs went off, a tourniquet became the most important tool.
"First thing, get the bleeding under control," said Sparks, who also is a nurse with a team from the National Medical Disaster System and was well-prepared for what happened. "They were breathing, so basic first aid — knowing how to tourniquet a wound and then elevating the limb — is what saved so many," she said.
The tent was staffed with nurses and physicians, and ambulances already were staged at the scene. These resources made a huge impact on wait times for life-saving care and helped limit fatalities to three at the scene and none among those taken to area hospitals, Hughes said.
Safety first
Preparation is key to minimizing loss when unexpected tragedies occur. Pattillo called this kind of preparation "mitigation," which the Federal Emergency Management Agency describes as actions taken prior to a disaster to prevent the loss of lives and property damage and to reduce the effects of the disaster.
Pattillo cautioned nurses to know their surroundings when they act during a disaster. "Nurses are a valuable asset," she said. "You?ve got to know your role to stay safe." She urged nurses not to go into the "hot zone" of a disaster without training.
Nurses are well-equipped to serve in disaster preparedness leadership roles in their communities. Pattillo encouraged them to join citizen emergency response teams, which provide training such as first aid and disaster preparedness to all citizens.
"We all need to be personally prepared," said Casey-Lockyer, noting that when emergency events strike a community, nurses are called into their acute care facilities, so they need to have a plan with their families and children on what to do and where to go when the nurse cannot come home.
"I think that everybody who is a nurse understands that when a community is hit by some kind of disaster, sometimes the first people that neighbors come to is the nurse to ask the questions," she said. •
