When disaster hits, ED nurses are at high risk

You’re on the front lines, so protect yourself

Leaking chemicals. Fuel in stagnant floodwaters. Contamination from human waste. Mosquito-borne illnesses from standing water. Toxic gases and particulates from fires.

These are some of the hazardous substances faced by ED nurses during Hurricane Katrina, which underscores the need to be vigilant about using personal protective equipment during disasters, says Bettina Stopford, RN, FAEN, PMP, director of public health and medical emergency preparedness for homeland security support division of McLean, VA-based Science Applications International Corp. and former nursing operations manager for the ED at Denver Health Medical Center.

"Hazards to an emergency nurse can be unpredictable, depending on the type and magnitude of a disaster," she points out. "Awareness, surveillance, and consistent, stringent adherence to infection control principles will save your life."

As an ED nurse, you are at higher risk for being exposed to hazardous substances and infectious diseases during disasters, warns Sharon S. Cohen, RN, MSN, CEN, CCRN, clinical nurse specialist for North Broward Hospital District in Fort Lauderdale, FL. "Risks include downed power lines, falling debris, and diseases such as tuberculosis, dysentery, viral infections, and skin infections," she says.

To protect yourself at triage, take the following steps during a disaster:

• Have patients wear a mask.

Ask patient coming into the ED with coughing, sneezing, or respiratory type of signs and symptoms to put on a protective mask. "Although it may not protect others in the ED areas 100%, it is better than having them wear nothing at all," Cohen says.

• Know when an N-95 mask is not enough.

ED nurses are accustomed to using universal protection to protect against bloodborne pathogens, but nurses often don’t protect themselves adequately from infectious disease transmission, says Mitch Saruwatari, MPH, national threat assessment manager at Kaiser Permanente in Pasadena, CA.

"As we know from the avian flu and SARS [severe acute respiratory syndrome], a regular N-95 might not be enough. If aerosolized, a patient exposure may require advanced levels of protection," he says.

You also must consider airborne and droplet precautions, says Stopford. "While a properly fitted N-95 style mask should be appropriate for most diseases, there are threats of weaponized diseases which will not be filtered by an N-95 mask," she says.

If it is a biological agent, respiratory protection such as a surgical mask, powered air-purifying respirator, or high-efficiency particulate air-filtered (HEPA-filtered) mask may need to be used, says Cohen. "If splash or contamination by liquid is possible, then splash protection such as nitrile gloves, Tyvek chemical protective suit and eye protection, and chemical booties is needed," she says.

N-95 masks are only for respiratory protection and will not protect against splashes into the eyes or other skin areas, notes Cohen. "These are meant to be worn in normal oxygen environments, not low oxygen environments such as a fire," she says.

Also, the mask must be worn correctly to offer maximum benefit, Cohen adds. "Over time as particulate builds up, the mask will be more difficult to breathe through and possibly offer less filtering potential."

• Have a high index of suspicion.

Add epidemiological screening questions to your routine assessments, says Stopford. "Be aware of emerging threats, pay attention to public health alerts, and become familiar with patterns of suspicious diseases," she says. These suspicious diseases include flu signs and symptoms outside of flu season and rapidly progressing respiratory symptoms, especially in patients not in high-risk categories, says Stopford.

Despite your best efforts, the fact remains that as an ED nurse, you won’t always know when a patient with an unusual illness or chemical exposure walks in the door, notes Saruwatari. "It’s important to develop appropriate screening protocols and work closely with local public health and response agencies to get early warning of potential dangers entering your facility," he says.

Sources

For more information on protection from hazardous substances, contact:

  • Sharon S. Cohen, RN, MSN,CEN, CCRN, Clinical Nurse Specialist, Emergency Preparedness, North Broward Hospital District, 303 S.E. 17th St., Fort Lauderdale, FL 33316. Telephone: (954) 355-4990. Fax: (954) 468-5270. E-mail: sscohen@nbhd.org.
  • Mitch Saruwatari, MPH, Threat Assessment Management, Kaiser Permanente, 100 S. Los Robles, Suite 100, Pasadena, CA 91188. Telephone: (626) 564-3817. E-mail: Mitch.Saruwatari@kp.org.
  • Bettina Stopford, RN, FAEN, PMP, Director, Public Health and Medical Emergency Preparedness, Homeland Security Support Division, Science Applications International Corporation, 8301 Greensboro Drive, MS E-1-6, McLean, VA 22102. Telephone: (703) 676-6348. Fax: (703) 676-5578. E-mail: stopfordb@saic.com.