TAN Issue: November/December 2001: Features: Are we ready to respond? Assessing Nursing's Bioterrorism Preparedness

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With new cases of anthrax cropping up and the specter of more terrorist attacks looming, many nurses and other health care professionals have been forced to learn on the fly about treating victims of bioterrorism, as well as to re-think their hospital and community disaster plans.

ANA wants to ensure that registered nurses will be able to respond effectively to these new types of emergencies and is working on several fronts to achieve this goal.

Since 1998, ANA has been serving on an American College of Emergency Physicians (ACEP) task force to develop strategies that will equip health care professionals with the information they need to deliver competent care to casualties resulting from nuclear, biological or chemical incidents. In April 2001, the task force submitted its report to the Health and Human Services (HHS) Office of Emergency Preparedness with a list of recommendations. Among them was to ensure that nurses' basic education includes information on responding to mass casualty situations. Further, the task force recommended that self-study modules and other specialty curriculum be developed for new and current ER nurses that would contain more in-depth information.

In addition, non-ER nurses who might be brought in to handle casualties also need educational programs that include information on how they can protect themselves and meet the immediate health care needs of disaster victims, said Cheryl Peterson, MSN, RN, ANA senior policy fellow and ACEP task force member.

The task force currently is waiting for federal funding to begin its second phase, which will address actual curriculum development and breaking down the barriers that might prevent these programs from being adequately implemented.

In July 2001, the ANA participated in the initial pilot test for the Integrated Health and Medical Weapons of Mass Destruction (WMD) Training Program, under development by the HHS Office of Emergency Preparedness. This was the first run of a comprehensive, integrated WMD education program designed for health care providers. Its goal is to provide specific information with regard to WMD agents and to demonstrate the need for coordination and communication between emergency responders and hospital/health systems.

Last month, ANA joined Sens. Bill Frist (R-TN) and Edward Kennedy (D-MA) along with other health care provider organizations at a Capitol Hill press conference announcing the launch of a coordinated effort to support a bioterrorism curricula at medical schools and the training and education of front-line providers.

Hospitals, doctors, nurses and public health professionals are on the front lines of any attack, stated Kennedy at the Nov. 1 event. "Our national response has to be based on the fundamental pillars of prevention, detection, containment and treatment," he said. "A key part of that response is to train health professionals to recognize the symptoms of a bioterrorist attack, so that prompt action can be taken to treat the victims and prevent the spread of the disease."

Frist, who is a physician, added, "We must ensure our nation's health professionals are properly trained to identify and treat the victims of a bioterrorist attack by making bioterrorism curricula a standard," at schools across the country. Strengthening the capability of health care workers and hospitals to respond to a bioterrorist attack was a critical component of the Frist-Kennedy "Public Health Threats and Emergencies Act," which was signed into law last year. Both senators are urging that funding be appropriated for the bill and are currently working on a separate piece of legislation to address bioterrorism.

"As was demonstrated in the days following the [Sept. 11] tragedy, nurses are the backbone of the health care system," Foley told reporters at the press conference. "As the nation braces for possible future terrorism attacks, nurses are no less vital to ensuring that hospitals and communities are prepared to handle emergency and disaster relief efforts. Nurses, like other health care workers, need to be educated in this area."

To that end, the ANA also has been involved in the International Nursing Coalition for Mass Casualty Education, which is looking at nursing education and preparedness. The goal of this coalition is to define basic nursing competencies for response to mass casualty situations, design continuing education programs for practicing nurses and propose advanced competencies for nurses who play strategic leadership roles in emergency response.

North Carolina Nurses Association member Mike Boucher, MSN, RN, believes that providing RNs with more education is vital to their ability to respond to crises effectively.

"America looks to nurses as their advocates in health care," said Boucher, a MICU staff nurse and alternate emergency preparedness coordinator at the Department of Veterans Affairs Medical Center in Durham. "They come to us with their questions and we need to be knowledgeable about what's going on out there."

He believes every RN in the country should be trained at the basic "awareness" level, as defined by the Centers for Disease Control and Prevention (CDC). This means RNs must be aware that biological agents, like anthrax or smallpox, exist and know their likely presentations.

Further, nurses must be alert to unusual patterns developing, such as if they begin to see clusters of people with flu symptoms outside the flu season or skin rashes, he said. (See box at left for other recommendations.) RNs then should know who they need to report these incidents to in their area.

He also believes in more extensive training for nurses who provide primary care or who are front-line caregivers in the ambulatory care arena and nurses, like himself, who are responsible for responding to a nuclear, biological or chemical threat.

In another key role, ANA is participating in an advisory committee to Booz, Allen & Hamilton, which was awarded an Agency for Healthcare Research and Quality grant to examine health care facilities' ability to respond to a bioterrorist event.

"The committee will be looking at hospitals' current disaster plans and many other specific factors," said Peterson, who also is serving on this committee. Those factors might include determining whether facilities have mechanisms in place that will allow them to up-staff quickly, whether they have enough ventilators on site and how they might work with other area facilities to respond in the most effective manner.

Boucher believes that every hospital should have basic detection and decontamination equipment and people trained to use it 24 hours a day, seven days a week.

To assist RNs who are in the U.S. Reserves and nurse volunteers, ANA is developing a document to help them understand their workplace rights when they respond to emergencies. And through its Web site, ANA will be offering links to other key Web sites providing up-to-date information regarding emergencies affecting the nation.

Boucher wants to see increased RN participation in the National Disaster Medical System and an overall increase in the number of Metropolitan Medical Response Teams throughout the country.

And, he said all health care facilities must develop effective disaster plans and conduct realistic drills based on those plans routinely.

"With the WTC disasters, we saw that these things really happen," he said. "Nurses' chances of surviving a disaster -- and the chances of their patients surviving -- will improve if they know what to do."

What to look for

The Association for Professionals in Infection Control and Epidemiology Bioterrorism Task Force has identified the following as potential signs of a bioterrorist attack:
* a rapidly increasing disease incidence in a normally healthy population
* an epidemic curve that rises and falls during a short time
* an unusual increase in the number of people seeking care, especially those with fever or respiratory or gastrointestinal complaints
* an endemic disease that rapidly emerges at an uncharacteristic time or in an unusual pattern
* an increased incident of illness among people who frequently go outdoors as compared with those who typically remain indoors
* clusters of patients arriving from a single locale
* large numbers of rapidly fatal cases.

Health care providers should form partnerships with their local public health agencies to learn who to report potential signs of bioterrorism to enable the development and easy dissemination of treatment protocols.

Resources on bioterrorism, preparedness

Centers for Disease Control and Prevention -- www.bt.cdc.gov -- Health alerts, updates, FAQs

U.S. Army Office of the Surgeon General -- www.nbc-med.org

Association for Professionals in Infection Control and Epidemiology -- www.apic.org -- Biological Warfare Readiness Plan

Federal Emergency Management Agency -- www.fema.gov

U.S. National Response Center -- www.nrc. uscg.mil -- Chemical/biological hotline and help-line information

National Disaster Medical System -- U.S. Department of Health and Human Services, Office of Emergency Preparedness -- www.ndms.dhhs.gov/oep/

enter for Civilian Biodefense Studies -- www.hopkins-biodefense.org

American Red Cross -- www.redcross.org -- Anthrax FAQs, Red Cross response

American Journal of Public Health -- May 2001, Vol. 91, No. 5 -- Bioterrorism Preparedness