- Email: [email protected]
Disaster preparedness—the courage to respond
PH C
GUEST EDITORIAL
Disaster Preparedness— The Courage to Respond
R i ch a r d R i c c i a r d i , M S , R N , C P N P / F N P
T
his issue of the Journal is dedicated to the women, men, and children who, during times of a natural or humanmade disaster, responded by giving selflessly of themselves for the benefit of us all. It is with heavy hearts that we remember and honor those who made the ultimate sacrifice as a result of or in the aftermath of the devastating acts of terrorism that occurred 1 year ago. The world will never be the same again. How many times have we spoken those words since September 11, 2001? I grew up in New York City and felt shock, anger, worry, uncertainty, and helplessness in the wake of the attacks. I was at home, less then 10 miles from the Pentagon, when the attack occurred, and I remember wondering what I could do to help those in need. Should I get on my bicycle and ride there and begin to triage and provide emergency care? We have had 1 year to reflect on the events of September 2001. During this time, we have been saturated with images, commentary, and articles depicting the evils of terrorism. The threat of biologic, radiologic, and chemical agents has become a reality. As the reality and ongoing threat of terrorism became a part of our daily lives, we asked ourselves how this would affect our families, our nurse practitioner practice, our health care systems, our communities, and our souls. Remarkably and instinctively, we have come together to fight terrorism as a unified group of Americans. As my fa-
September/October 2002
ther would say, we “buckled down” and rose to meet the enemy head on. We realize that indeed the world will never be the same after September 11, 2001. However, we are not the first to experience such a realization. These
H
istory reminds us
that we are not the first generation to deal with disaster, and that healing and enlightenment are possible.
same words have been spoken in reference to other periods of our history. I envision citizens of this great country discussing how the world will never be the same during and after the American Revolution, Civil War, the stock market
crash, World War I and II, and the Holocaust. History reminds us that we are not the first generation to deal with disaster, and that healing and enlightenment are possible. A disaster can be defined as a natural process or an event caused by humans that deprives people of life, health, livelihood, or property and with which the affected country cannot cope (United States Agency for International Development, 2002). As primary care providers, pediatric nurse practitioners will be called upon not only to be first responders in times of a community disaster but to ensure that the health care needs of children are addressed in local and national disaster response plans as well. Designing a community and national disaster response plan will require multidisciplinary collaboration at the highest and, perhaps, unprecedented levels, including forming partnerships with experts in public health, infectious disease, the military, academic centers, and nongovernmental agencies. This is a formidable challenge considering the limited amount of information currently taught on disaster management and treatment of biologic, radiologic, or chemical injuries in most advanced practice nursing
Richard Ricciardi is Adjunct Assistant Professor, Uniformed Services University of the Health Sciences, Bethesda, Md. He is also the Treasurer of NAPNAP. Reprint requests: Richard Ricciardi, MS, RN, CPNP/FNP, 6815 Meteor Place Apt. 302, Springfield, VA 22150; e-mail: [email protected]. J Pediatr Health Care. (2002). 16, 211-212. Copyright © 2002 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2002/$35.00 + 0
25/8/127484
doi:10.1067/mph.2002.127484
211
PH GUEST EDITORIAL C curricula, and until recently, limited continuing education offerings. In developing a disaster response plan, much of what we can learn from and build on comes from governmental agencies such as the Department of Health and Human Services, the Federal Emergency Management Agency, and The Department of Defense, and from nongovernmental agencies such as the American Red Cross. As federal agencies reorganize and lines of authority are adjusted in the newly formed Department of Homeland Security, it is clear that nurses across all specialties will play a significant role in the overall medical disaster response strategy. The current Federal Response Plan has 12 emergency support functions, two of which involve the medical response. After acquiring additional education and hands-on training in the care of biologic, chemical, and radiologic casualties, it is my belief that advanced practice nurses will be well suited to be part of disaster medical assistance teams at the local, state, and federal level. The attacks of September 2001 quickly awakened the need to restructure our approach in responding to national disasters. Ongoing research on the many components of a medical response to a disaster is critical. One possible approach is to begin by assessing current strengths and identifying gaps in practice, education, research, and health policy, focusing primarily on three areas: patient/individual, health care provider, and the health care system. Disaster preparedness begins with education of the patient. Since September 2001, we seem to be facing a surge of questions from patients that are difficult to answer. One example is concerns regarding the use of vaccinations. When vaccines for smallpox, anthrax, or other biologic agents become available, who should receive them? Difficult questions arise regarding vaccination of bio-
212
Volume 16 Number 5
Ricciardi
logic agents in children, either as a prophylactic measure or as treatment during a suspected or confirmed exposure. Another critical area is the psychological effect of disasters and terrorism on the patient, family, and community. Two articles presented in this issue of the Journal specifically focus on the key psychological components regarding children and their response to disasters.
D
esigning a
community and national disaster response plan will require multidisciplinary collaboration at the highest and, perhaps, unprecedented levels
NAPNAP is currently partnering with the American Academy of Pediatrics to take an active role in incorporating the unique needs of children in the Federal Response Plan. In the current disaster response plan, specialty disaster medical assistance teams have been designated to care for trauma, burn, and pediatric patients. A second area to focus on is the safety and educational needs of health care providers. During a disaster, safety of all personnel is at the forefront. The disaster response plan should include terms to provide the most up-to-date technology and tools to ensure the safety of all heath care workers. Com-
munication at both the local and national level is critical. I believe, in the event of bioterrorism, the Centers for Disease Control and Prevention will become the best source of information on treatment and threat risk. The ongoing educational needs of the nurse practitioner may be most efficiently met by utilizing distance education technologies and courses on the Web. Many universities have begun to integrate content into the curriculum regarding identification and treatment of biologic, radiologic, and chemical agents. The third area to review is the health care system’s ability to successfully respond to a disaster. Organizations like the Armed Forces, Public Health Service, and the American Red Cross have a long history of providing health care in austere and disaster settings, and they provide a wealth of information from nurses with firsthand experience regarding agent identification, evacuation, decontamination, personal safety, command and control, equipment needs, and training. Testing the preparedness of the health care system and providing continuing education to health care providers will be expensive, and questions regarding how costs will be distributed will need to be answered. Someone once told me that courage is defined by the ability to move forward not knowing the outcome. The truth is that no one can predict the location, timing, or nature of the next disaster, just that another disaster is inevitable—so we must be prepared!! If you have any comments, please write to me at the following e-mail address: [email protected]. MIL.
REFERENCE United States Agency for International Development. (2002). Automated Directives System, Series 200, Chapter 251. Retrieved from http://www.usaid. gov/pubs/ads/glossary.doc
JOURNAL OF PEDIATRIC HEALTH CARE
GUEST EDITORIAL
Disaster Preparedness— The Courage to Respond
R i ch a r d R i c c i a r d i , M S , R N , C P N P / F N P
T
his issue of the Journal is dedicated to the women, men, and children who, during times of a natural or humanmade disaster, responded by giving selflessly of themselves for the benefit of us all. It is with heavy hearts that we remember and honor those who made the ultimate sacrifice as a result of or in the aftermath of the devastating acts of terrorism that occurred 1 year ago. The world will never be the same again. How many times have we spoken those words since September 11, 2001? I grew up in New York City and felt shock, anger, worry, uncertainty, and helplessness in the wake of the attacks. I was at home, less then 10 miles from the Pentagon, when the attack occurred, and I remember wondering what I could do to help those in need. Should I get on my bicycle and ride there and begin to triage and provide emergency care? We have had 1 year to reflect on the events of September 2001. During this time, we have been saturated with images, commentary, and articles depicting the evils of terrorism. The threat of biologic, radiologic, and chemical agents has become a reality. As the reality and ongoing threat of terrorism became a part of our daily lives, we asked ourselves how this would affect our families, our nurse practitioner practice, our health care systems, our communities, and our souls. Remarkably and instinctively, we have come together to fight terrorism as a unified group of Americans. As my fa-
September/October 2002
ther would say, we “buckled down” and rose to meet the enemy head on. We realize that indeed the world will never be the same after September 11, 2001. However, we are not the first to experience such a realization. These
H
istory reminds us
that we are not the first generation to deal with disaster, and that healing and enlightenment are possible.
same words have been spoken in reference to other periods of our history. I envision citizens of this great country discussing how the world will never be the same during and after the American Revolution, Civil War, the stock market
crash, World War I and II, and the Holocaust. History reminds us that we are not the first generation to deal with disaster, and that healing and enlightenment are possible. A disaster can be defined as a natural process or an event caused by humans that deprives people of life, health, livelihood, or property and with which the affected country cannot cope (United States Agency for International Development, 2002). As primary care providers, pediatric nurse practitioners will be called upon not only to be first responders in times of a community disaster but to ensure that the health care needs of children are addressed in local and national disaster response plans as well. Designing a community and national disaster response plan will require multidisciplinary collaboration at the highest and, perhaps, unprecedented levels, including forming partnerships with experts in public health, infectious disease, the military, academic centers, and nongovernmental agencies. This is a formidable challenge considering the limited amount of information currently taught on disaster management and treatment of biologic, radiologic, or chemical injuries in most advanced practice nursing
Richard Ricciardi is Adjunct Assistant Professor, Uniformed Services University of the Health Sciences, Bethesda, Md. He is also the Treasurer of NAPNAP. Reprint requests: Richard Ricciardi, MS, RN, CPNP/FNP, 6815 Meteor Place Apt. 302, Springfield, VA 22150; e-mail: [email protected]. J Pediatr Health Care. (2002). 16, 211-212. Copyright © 2002 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2002/$35.00 + 0
25/8/127484
doi:10.1067/mph.2002.127484
211
PH GUEST EDITORIAL C curricula, and until recently, limited continuing education offerings. In developing a disaster response plan, much of what we can learn from and build on comes from governmental agencies such as the Department of Health and Human Services, the Federal Emergency Management Agency, and The Department of Defense, and from nongovernmental agencies such as the American Red Cross. As federal agencies reorganize and lines of authority are adjusted in the newly formed Department of Homeland Security, it is clear that nurses across all specialties will play a significant role in the overall medical disaster response strategy. The current Federal Response Plan has 12 emergency support functions, two of which involve the medical response. After acquiring additional education and hands-on training in the care of biologic, chemical, and radiologic casualties, it is my belief that advanced practice nurses will be well suited to be part of disaster medical assistance teams at the local, state, and federal level. The attacks of September 2001 quickly awakened the need to restructure our approach in responding to national disasters. Ongoing research on the many components of a medical response to a disaster is critical. One possible approach is to begin by assessing current strengths and identifying gaps in practice, education, research, and health policy, focusing primarily on three areas: patient/individual, health care provider, and the health care system. Disaster preparedness begins with education of the patient. Since September 2001, we seem to be facing a surge of questions from patients that are difficult to answer. One example is concerns regarding the use of vaccinations. When vaccines for smallpox, anthrax, or other biologic agents become available, who should receive them? Difficult questions arise regarding vaccination of bio-
212
Volume 16 Number 5
Ricciardi
logic agents in children, either as a prophylactic measure or as treatment during a suspected or confirmed exposure. Another critical area is the psychological effect of disasters and terrorism on the patient, family, and community. Two articles presented in this issue of the Journal specifically focus on the key psychological components regarding children and their response to disasters.
D
esigning a
community and national disaster response plan will require multidisciplinary collaboration at the highest and, perhaps, unprecedented levels
NAPNAP is currently partnering with the American Academy of Pediatrics to take an active role in incorporating the unique needs of children in the Federal Response Plan. In the current disaster response plan, specialty disaster medical assistance teams have been designated to care for trauma, burn, and pediatric patients. A second area to focus on is the safety and educational needs of health care providers. During a disaster, safety of all personnel is at the forefront. The disaster response plan should include terms to provide the most up-to-date technology and tools to ensure the safety of all heath care workers. Com-
munication at both the local and national level is critical. I believe, in the event of bioterrorism, the Centers for Disease Control and Prevention will become the best source of information on treatment and threat risk. The ongoing educational needs of the nurse practitioner may be most efficiently met by utilizing distance education technologies and courses on the Web. Many universities have begun to integrate content into the curriculum regarding identification and treatment of biologic, radiologic, and chemical agents. The third area to review is the health care system’s ability to successfully respond to a disaster. Organizations like the Armed Forces, Public Health Service, and the American Red Cross have a long history of providing health care in austere and disaster settings, and they provide a wealth of information from nurses with firsthand experience regarding agent identification, evacuation, decontamination, personal safety, command and control, equipment needs, and training. Testing the preparedness of the health care system and providing continuing education to health care providers will be expensive, and questions regarding how costs will be distributed will need to be answered. Someone once told me that courage is defined by the ability to move forward not knowing the outcome. The truth is that no one can predict the location, timing, or nature of the next disaster, just that another disaster is inevitable—so we must be prepared!! If you have any comments, please write to me at the following e-mail address: [email protected]. MIL.
REFERENCE United States Agency for International Development. (2002). Automated Directives System, Series 200, Chapter 251. Retrieved from http://www.usaid. gov/pubs/ads/glossary.doc
JOURNAL OF PEDIATRIC HEALTH CARE