Editors Note: This article is the first in a periodic series focusing on emergency management and how its principles can be incorporated into nursing practice.
One of my first student nursing courses expounded on the numerous fields of study and specialties a nurse can enter. The variety of options is one of the reasons I chose the profession.
However, I didn't know my nursing career would lead me down the path of emergency management. It certainly wasn't one of the options discussed in that course - not surprising, considering this was before 9/11, and the changes it brought.
In my senior year, I landed a paid internship at the Maryland Emergency Management Agency's Office of Homeland Security, whetting my appetite for this type of nursing. So, after a year cutting my teeth in an emergency department (ED) as a new nurse, I decided to get back into emergency management from the clinical side. I took a post at the Baltimore City Health Department (BCHD).
Becoming a Subject Matter Expert
At BCHD one of my jobs was serving on the response wing at the Office of Public Health, Preparedness and Response. During the first year, I responded to Hurricane Isabel and participated in various exercises.
Near the end of my second year, I became a Metropolitan Medical Response System member and was deployed with Maryland Task Force 2 (MDTF 2) Urban Search and Rescue Team to Katrina.
I was a last-minute addition because team leaders realized they didn't have a nurse on the team. Having someone on hand who knows how to prepare antibiotics and handle pharmacy caches would be a good idea, they realized. I asked why there wasn't a permanent nursing team and was told the Federal Emergency Management Agency (FEMA) didn't require one.
Six months later, I was offered a job at IEM, an independent contracting firm headquartered in Baton Rouge, LA, specializing in various disciplines in emergency management. I was considered a health and medical subject matter "expert," the first time anyone ever called me that!
Through the years, I have been assigned multiple projects including capability assessments, review and production of plans, and planning and executing exercises, working with states, regions, counties, cities and even individual agencies.
Where are Nurses?
While I may have been considered a subject matter expert, I've noticed nurses are usually absent from the planning process, even in hospitals. When they are involved, it is typically as a secondary duty for an otherwise overwhelmed ED, critical care or public health nurse.
The lack of nursing presence is understandable, but unfortunate - nurses must, if only briefly, move away from the bedside to participate in planning sessions.
A nurse brings a great deal of knowledge to the planning process. Had a nurse been on the planning team early in MDTF 2's development, the roles nurses can play on the team might have been identified.
I accepted the job at IEM to be a voice for increasing nursing presence in the planning process. This meant leaving the clinical setting.
Trading in my stethoscope for a computer has allowed me to interject nursing concerns into emergency planning and guidance.
As wonderful as the opportunity is, I'm just one voice; I need nurses in the field to seek out areas where they can help emergency planners. Being a nurse who can help in emergency preparedness doesn't require giving up bedside nursing as I have.
How to Get Started
Nurses at hospitals, health departments, nursing schools and even private practice can learn the basics of how to produce an effective plan within or as a representative of their organization. The basics are simple.
Below is a list of resources to help:
- Emergency Management Institute, a division of FEMA, provides training courses in various subject areas. Though they do have in-residence courses, they also have free courses online which take 2 to 8 hours to complete. Courses include introduction to incident command system for hospitals, emergency planning, disaster basics, orientation on hazardous materials, national incident management and more.
- National Mass Fatalities Institute's online course on MFI Mass Fatality Institute.
- FEMA Technical Assistance is provided free to requesting agencies and jurisdictions.
- FEMA's Comprehensive Preparedness Guide 101 provides a thorough explanation of the planning process as well as planning templates.
Plans Must Include All Units
Every hospital and health department, no matter the size, needs to have an emergency plan that is exercised and reviewed annually. Often these plans focus on emergency medical services, the ED, and maybe the OR.
However, a disaster will impact nearly every service. Patients will leave the OR and can go to the floor, require physical and occupational therapy, repetitive imaging studies, lab work, medication, housekeeping services, insurance claims, and much more.
Savvy floor nurses could recognize the potential impact on their units and review the hospital's plan to ensure their concerns are met and considered.
The same can be said for private outpatient facilities. Elective surgeries and studies can be cancelled if a hurricane is bearing down. However, people will still need dialysis and chemotherapy.
Some health departments have made great headway in plugging specialty clinics into the community's emergency plans; many have not. Nurses working in these clinics should take the opportunity to advocate for patients and ensure restoration of these services is a priority to the jurisdiction's emergency management agency.
Emergency managers have a lot to worry about. Plans help them sort through the requests and make sure needs are prioritized and met in an orderly manner. However, things fall through the cracks. Nurses can help prevent their needs from being one of those things. If you never felt empowered to examine your agency's plans before, consider this article your invitation to do so now.
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Chris Hiles is an emergency manager at IEM, an emergency management contracting firm. He can be reached at firstname.lastname@example.org.