One year after the terrorist attacks, emergency departments (EDs) still are very much in a state of flux. ED nurses report a variety of concerns, coupled with continued revamping of disaster plans. Barbara M. Pierce, RN, MN, director of emergency services at Huntsville (AL) Hospital System, reports a "total revision and expansion" of her facility’s current disaster plan and more integration with city plans. She says the following are key points that have been addressed since 9/11:
• how to handle masses of the worried well;
• how to handle mass decontamination at the hospital;
• where to get the funds to properly outfit staff, train staff, and prepare facilities with a tight budget;
• how to evacuate an entire facility with all hospitals running on high censuses. "We are looking at how we would accomplish that if it was necessary," says Pierce. "We are working with our city to come up with alternatives."
Here are key concerns of ED nurses one year after 9/11:
• Will ED nurses receive the smallpox vaccine? Although at press time, a final decision had not been made as to whether health care workers will be vaccinated, ED nurses were anxiously awaiting the news. "I certainly want for ED personnel who will be caring for these patients to have that option," says Pierce. She has asked the facility’s employee health physician to help her plan for a possible vaccination of all ED staff. "I don’t know that we will make it mandatory, but I certainly want the staff to have the option if they would like to protect themselves, if and when vaccine is made available," she says.
• Is security adequate? Pierce says there is a better "lockdown" of the ED and the hospital, with badges required for access. "We have additional security cameras and additional private police agency coverage in addition to hospital-based security," she reports.
• How will overcrowded EDs handle a disaster? There is a concern about how to handle masses of people coming to the ED. "We are already so overloaded; how can we deal with many, many more?" asks Pierce.
• How can I educate agency nurses about preparedness? Kim Colonnelli, RN, BSN, director of emergency and trauma services at Palomar Medical Center in Escondido, CA, says her most pressing concern is the education of temporary or agency staff. "Due to the nationwide nursing shortage, which is critical in the state of California, we are relying heavily on agency staff," she says. "It is very difficult to ensure that they know what to do in the face of any type of disaster."
• How can EDs receive funding? Many EDs report a lack of funding for needed resources. "We have received none so far except for training, and we are hoping to get some funding for equipment," says Bonnie Kester, RN, ED nurse manager at Memorial Hospital in Carthage, IL. According to Kester, there is a lack of support for EDs in rural areas. "Small rural hospitals are struggling to provide services such as decontamination, but they are cost-prohibitive," she says. "We have asked administration for the financial resources to obtain a decontamination unit; but at this point, we have no decontamination capabilities."
• Should I attend conferences that require airplane travel? Some ED nurses still are avoiding attendance at conferences because they fear travel by plane. "I am still leery about getting on a plane and traveling cross-country," says Iris Frank, RN, MSN, formerly director of emergency services at Kaiser Permanente Santa Clara (CA) Medical Center.
• How can nurses protect themselves? ED nurses fear exposure to contaminated patients, says Pierce. Managers are training to help with their fears. "But they are real fears," Pierce says. She adds that the ED has been working with the city to come up with plans to train staff and address situations involving contaminated patients. "I think being prepared is the best way to address concerns," she concludes. Pierce adds that staff are continuously monitoring for patterns of illness that might represent bioterrorist attacks. "There is definitely a heightened awareness," she says.