Lessons in Emergency Preparedness

Ready . Set . Action: At 8:55 a.m. on a beautiful August morning, congregants of the Holy Order of Advocates for Xenon (HOAX) are touring a potential site for an expansion of their church. Suddenly, several explosions occur from possible terrorist action. The bombing causes injuries, a fire and the potential release of hazardous materials as the building burns and collapses. Observers at the site call 911 and the emergency response is activated.

Luckily, the site is located across the street from a hospital and once the initial shock is over, many victims begin to make their way across the street for medical assistance. The fire department arrives at the scene and declares a mass casualty incident. They must contain the hazmat contamination, triage and contain the wounded in case of contamination, and prepare for fire suppression activity.

This is not a scene from the latest episode of Grey’s Anatomy, but an all-inclusive practice drill for local firefighters, paramedics and various hospital departments at Signature-Healthcare Brockton Hospital located in southeastern Massachusetts. The Operation “HOAX” exercise was divided into three stages and offered an opportunity to observe and critique several aspects of emergency response procedures, particularly those policies involving hazardous materials.

Stage 1 included declaration of the emergency and notification to all personnel including ED staff, hospital security, hospital administration, the Brockton Fire Department (BFD), and American Medical Response paramedics. Stage 2 was the plan in action by all agencies. And, stage 3 consisted of a debriefing that becomes an important aspect of any drill to identify strengths as well as learning opportunities in the execution of the hospital’s or the BFD Emergency Operations Plan (EOP).

 

Teamwork
A catastrophic event can create significant demands that easily overwhelm a health delivery system. Preparedness is key in ensuring a viable plan is in effect should an emergency occur. As Americans live with daily threats of terrorism, natural disasters, and epidemics of life-threatening infectious diseases, it becomes increasingly important to maintain a high level of preparedness, not only at an organizational level, but among all public safety agencies as well. Emergency preparedness is a critical component for all organizations responsible for maintaining public health, including public safety systems at all levels, healthcare delivery systems, academia, and the media. This emergency management exercise provided an opportunity to execute the best thought-out plan for all involved.

Because nurses make up the largest group of healthcare professionals, they can be called upon to help manage a scene and arrange for the care of injured victims during an emergency. Consequently, nurses need to be aware of the emergency plans, as well as the scope and practice of the nurse in an emergency action plan. Developing an understanding of their role in the disaster is critical for a smooth and seamless response to the event.

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Triage Time: Decontaminated victims exiting the decontamination area are triaged and processed while observers and critics look on. Photo courtesy Brockton Hospital, Brockton, Mass.

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Team Effort: Before the diaster drill, Brockton Hospital nursing students pose with “Annie,” the School of Nursing’s simulation manikin. Later, “Annie” played the role of victim, helping the students hone their disaster-readiness skills.

This drill allowed the first responders an opportunity to work as a team with other delivery systems. The “HOAX” drill required firefighters and paramedics to evaluate the scene, triage injured victims, control traffic and, due to the exposure of hazardous material, activate the decontamination response procedures. It also allowed several departments in the hospital an opportunity to test the effectiveness of the communication system, including paging and overhead announcements; mobilizing staff to manage multiple victims; managing the registration process; securing the building to prevent contaminated victims from entering the facility other than through the Mobile Decontamination Unit (MDU); and alerting the media.

 

The Live Classroom
Senior level nursing students from the Signature Healthcare Brockton Hospital School of Nursing were fortunate to have a unique opportunity to not only witness the plan in action, but participate in the drill as the “HOAX” congregants who were injured in the blast. It was a classroom in the making as the students witnessed firsthand all the components and execution of the hospital’s emergency operation plan (EOP). To enhance the experience, students were given a reading assignment from their med/surg nursing textbook prior to the drill. Once the exercise was over, they were required to complete an anecdotal worksheet based on their reading assignment and their experiences during the drill. Students were required to answer questions regarding disaster nursing, the triage process, the nurses’ roles in various components of the plan, and the decontamination process. In addition, the students provided a unique evaluation of the drill as they were able to provide feedback from a patient’s perspective.

Because of the potential exposure to hazardous material, a Mobile Decontamination Unit (MDU) was erected by the BFD to process the victims so they did not enter the ED contaminated with hazardous material. Firefighters were responsible for containing the potential threat by blocking off an area and holding all victims in one location until the decontamination unit could be erected.

Once victims exited the unit, several nurses were waiting to triage and process the victims according to their injuries. One victim (a school of nursing manikin), suffered airway burns after breathing in heated gases from the explosion. After collapsing in the parking lot, the victim required swift decontamination by firefighters and was sent directly to the ED. “Airway swelling” inhibited intubation requiring the anesthesia department to respond. This scenario provided an opportunity for another critical hospital department to participate in the exercise and test their response readiness.

The drill did not obstruct caring and processing real patients who were brought to the ED. The only diversion to routine hospital operations was redirecting patients with cancers scheduled to receive radiation therapy from their usual parking space. This parking area is adjacent to the trailer that houses the MDU and served as space for the firefighters to access the trailer. All patients were previously notified of the drill and were provided alternative parking spaces.

 

SEE ALSO: Preparing Nurses Students for the ED

Collaborative Lessons Learned
In the final stage of the drill, a debriefing meeting occurred including the MDs in charge, nurse managers of ICU and ED, the BFD emergency instructor, the hospital safety officer, the school of nursing instructors, and a team of evaluators strategically placed in various areas during the exercise. This process provided an opportunity to assess every aspect of the drill and is critical for enhancing and streamlining the plan.

Health delivery systems work in direct collaboration with other service providers who all have unique roles in the emergency plan. Each component must be able to effectively do their part in maintaining public safety and well-being while caring for affected individuals. Disaster drills are an effective way to test preparedness and ensure effective policies and procedures are in place. Setting up the MDU requires a periodic refresher and this drill provided an opportunity to practice as well as teach novice firefighters. ED nurses and nursing students participating in this drill witnessed firsthand how the scope of their practice can be pushed to the extreme. The guided anecdotal and post-simulation debriefing afforded the students an opportunity to apply theory to practice with disaster nursing concepts, as well as enhance their knowledge of a hospital’s EOP. Nursing students who participated were fortunate to have experienced such a complex exercise that tested the resources of many facets of a healthcare community in a world filled with a multitude of potential threats.

Claudette Kistner is nursing instructor at Brockton Hospital, Brockton, Mass.

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