New report provides benchmark’ for disaster training in the ED

In light of the recent terrorist attacks on New York City and Washington, DC, the critical question arises: Are you adequately trained for a disaster? It’s not a simple question to answer, but now you have a measuring stick to assess how well you are prepared.

A new report from the Dallas-based American College of Emergency Physicians (ACEP) and the U.S. Department of Health and Human Services (HHS) Office of Emergency Preparedness gives you a "benchmark" to prepare for nuclear, biological, and chemical (NBC) incidents with specific training objectives.

Disaster training

The report recommended that training start in nursing school and provides an overview of nursing roles in a disaster, says Bettina Stopford, RN, chair of the national Weapons of Mass Destruction (WMD) work group for the Des Plaines, IL-based Emergency Nurses Association and chief nurse for the Denver-based U.S. Public Health Service’s Central U.S. National Medical Response Team for WMD. (See specific recommendations of the report, below.)

The report gives you specific guidelines for what your disaster training should include, says Stopford.

Stopford recommends the following to comply with the recommendations of the report:

• Have an active plan in place in advance to mitigate the long-term effects of a large-scale disaster.

• Ensure that ED staff education has a functional component. (See list of training courses to take, below.)

• Give nurses hands-on training with appropriate personal protective equipment. (For more information on secondary contamination, see ED Nursing, August 2001)

• Make sure you experience the role changes or expanded roles required in a disaster.

• Include a role review, Incident Management System review, and a brief tabletop-type exercise for orientation.

• Provide nurses with a brief annual review, along with the two disaster drills required by the Joint Commission on Accreditation of Healthcare Organizations. "This can be tagged onto the infection control and safety training review which is required annually," Stopford suggests.

• Practice the following:

— safety/ED lockdown;

— staff recall lists;

— rapid triage such as Simple Triage and Rapid Treatment, developed by the Hoag Hospital in Newport Beach, CA, and the Newport Beach Fire Department for a multiple casualty incident;

— triage to other areas of the hospital;

— role identification;

— supplies;

— personal protective equipment;

— the Incident Management System such as Hospital Emergency Incident Command System, an emergency management system made up of positions on an organizational chart, developed by the San Mateo (CA) County Health Services Agency;

— communication, including broadcast, fax, and radios;

— decontamination;

— active surveillance systems;

— contact with resources;

— integration with the community for resources.

• Hold an annual tabletop drill for managers and charge staff. "You need to see what kind of thinking needs to take place to best manage a disaster," says Stopford. "This should be followed up by a hands-on drill with mock victims."

Report’s Recommendations

  • Develop a continuing education course covering the weapons of mass destruction (WMD) performance-level objectives for all emergency nurses.
  • Use both self-study and instructor-led continuing education programs.
  • Work with professional organizations to promote integration of the WMD content into established hospital training programs.

Source: American College of Emergency Physicians, Dallas, and Office of Emergency Preparedness. Developing Objectives, Content, and Competencies for the Training of EMTs, Emergency Physicians, and Emergency Nurses to Care for Casualties Resulting from NBC Incidents. Washington, DC.

Source and Resources

For more information about the American College of Emergency Physicians and Department of Health and Human Services report, contact:

Bettina Stopford, RN, Denver Health Medical Center, 777 Dannock St., MC 8200, Denver, CO 80204. Telephone: (303) 436-3431. Fax: (303) 436-6828. E-mail: bettina.stopford@dhha.org.

The full 197-page report, Developing Objectives, Content, and Competencies for the Training of Emergency Medical Technicians, Emergency Physicians, and Emergency Nurses to Care for Casualties Resulting From Nuclear, Biological, or Chemical (NBC) Incidents from the American College of Emergency Physicians (ACEP) and the Office of Emergency Preparedness can be downloaded free of charge at ACEP’s web site www.acep.org. Click on "EM Practice," "EMS," and "NBC Final Report."

Louisiana State University offers training for health care providers in counterterrorism. Courses include Emergency Response to Domestic Biological Incidents. For more information, contact:

Louisiana State University, Academy of Counter-Terrorist Education, 334 Pleasant Hall, Baton Rouge, LA 70803. Telephone: (225) 578-1375. Fax: (225) 578-9117. E-mail: ace@doce.lsu.edu. Web: www.doce.lsu.edu/ace.

The U.S. Public Health Service offers instruction for health care personnel, including how to protect yourself from the effects of weapons of mass destruction, techniques and methods to protect the hospital physical plant, and current treatments for injuries/illnesses from nuclear, biological, or chemical incidents. For more information, contact:

U.S. Public Health Service Noble Training Center, P.O. Box 5237, Fort McClellan, AL 36205. Telephone: (256) 820-9135. Fax: (256) 820-8694. Web: www.ndms.dhhs.gov. (Click on "Links," then "Federal Counterterrorism Sites," then "Noble Training Center.")