Ready for Anything

In the wake of the September 11 terrorist attacks and the anthrax scare of fall 2001, American nurses can no longer observe a troubled world and reassure themselves that terrorism won’t happen here. But they can be prepared to respond if terrorists strike again

The nation is counting on nurses to play a vital role in responding to any future terrorism disasters that may occur. Specifically, nurses will be needed to work on the front lines to treat victims, educate other medical professionals, teach communities about emergency preparedness and help people cope in the aftermath of attacks.

Nurses are a natural choice for this role because they consistently rank among the nation’s most trusted professionals--a key benefit as they work to prepare communities for eventualities that most Americans find terrifying. And because “dirty bombs,” chemical weapons and anthrax spores don’t discriminate on the basis of skin color or ethnicity, minority nurses who can provide culturally and linguistically competent public health preparedness to diverse communities will be urgently needed.

“Hospitals must assign leaders to help them prepare for terrorist disasters,” says Greg Evans, PhD, MPH, director of the Center for the Study of Bioterrorism and Emerging Infections at the St. Louis University School of Public Health. “Nurses, rather than doctors, are the ones to fill those important leadership roles.” To do so, he adds, nurses will need training in disaster preparedness, bioterrorism and leadership skills.

To meet that need, the federal government, nursing associations, schools of nursing and health care systems are all working to train, educate and organize nurses to respond to terrorism, as well as other potential public health emergencies, such as the recent Severe Acute Respiratory Syndrome (SARS) epidemic. Government officials and nursing leaders are encouraging nurses who want to help after catastrophes to join organized efforts so they can get the proper training and be part of systematic responses.

In June 2002, President Bush signed into law the Public Health Security and Bioterrorism Response Act, which authorized significant funding improvements in public health infrastructure and emergency health preparedness. Currently, several major national initiatives are under way, giving nurses a variety of different channels through which they can serve.

The National Nurses Response Team

The American Nurses Association (ANA) and the U.S. Department of Health and Human Services’ Office of Emergency Response are establishing the National Nurses Response Team, a force of registered nurses trained to respond to a major bioterrorism event, such as the release of smallpox or anthrax. The nurses would be responsible for providing mass vaccinations or chemoprophylaxis to hundreds of thousands of Americans, or even millions.

The association and federal officials want to recruit 10 regional teams of 200 nurses, says ANA senior policy analyst Cheryl Peterson, RN, MSN. In case of a terrorism disaster, the federal government would deploy nurses on the team for no more than two weeks at a time and would pay them for their service

Racial and cultural diversity in the response team will be critical, as it is in all areas of nursing, Peterson stresses. The team must be able to communicate medical information and educate the public quickly after a crisis. Nurses of color can play a key role in helping other members of the team understand diverse cultures, establishing trust in minority communities, responding to individual and community needs with cultural sensitivity and communicating with limited-English-speaking populations.

According to Peterson, public health experts were already studying how to better inform nurses about bioterrorism even before 9/11. After a religious cult released sarin, a nerve gas, in a Tokyo subway in 1995, an American College of Emergency Physicians task force studied whether health care providers were ready to respond to such a disaster here. The answer was no, Peterson says. That revelation, along with the attacks on the World Trade Center and Pentagon and the subsequent anthrax incidents, served as an alarming wakeup call.

Nurses who join the National Nurses Response Team will be trained through national online courses and regional continuing education programs. Peterson says officials hope to have the team in place by the end of this year.

Serve Nationally, Locally or Both

Although the National Nurses Response Team is a particularly exciting initiative because it focuses exclusively on nurses, it is not the only option available to nursing professionals who want to make a difference in helping their country prepare for and respond to the threat of terrorism. Here are several other programs in which nurses can make valuable contributions:

• Disaster Medical Assistance Teams. A Disaster Medical Assistance Team (DMAT) is a group of medical personnel who work on the front lines providing medical care after a disaster. This can include natural and environmental disasters as well as terrorist attacks. The teams, which are part of the federal government’s National Disaster Medical System, are deployed to disaster sites with enough equipment and supplies for 72 hours. They help triage victims and prepare patients for evacuation. They can also help relieve local health care staffs that become overloaded during a crisis. The team members are paid by the federal government while serving, and their medical or nursing licenses are recognized in every state during their service.
• Medical Reserve Corps. These groups are part of the USA Freedom Corps, an initiative developed after President Bush’s 2002 State of the Union address called for establishing a new program to give Americans the opportunity to volunteer and serve their communities. After September 11, many people across the country felt a renewed surge of civic duty but weren’t sure how or where they could help. Although the federal government helps fund the Medical Reserve Corps through grants, the groups are actually developed and run by individual communities so they can design the corps to respond to local needs. According to Craig Stevens, a spokesman for the U.S. Surgeon General’s office, any organization or group can start a Medical Reserve Corps, and volunteers don’t necessarily have to be health care professionals to take part. So far hospitals, churches, Rotary Clubs, fire departments and ­even a community newspaper ­have launched these volunteer efforts in 42 communities nationwide. Not only can local Medical Reserve Corps groups be organized to respond to disasters, they can also serve ongoing public health needs, says Stevens. For example, they may provide health education or develop vaccine programs. Nurses obviously can play a huge role in establishing Medical Reserve Corps units, he adds. And because these programs are so strongly community-focused, they can be a particularly effective way for minority nurses to establish culturally competent emergency preparedness efforts in communities of color.
• American Red Cross. Registered nurses can join their local Red Cross chapters to get training and local experience in terrorism preparedness. They can also receive additional training to respond to disasters outside their communities. The length of assignment depends on the type and location of the disaster. Nurses who serve away from their local areas should be able to commit to at least two weeks deployment. Nurses can serve in a variety of ways through the Red Cross. They can provide community disaster education, recruit and train other nurses, work at Red Cross service centers and provide health assessments and first aid for Red Cross workersresponding to disasters.
• Commissioned Corps Readiness Force. Nurses who work in the U.S. Public Health Service’s Commissioned Corps can volunteer for the Readiness Force, which deploys teams to respond to major public health emergencies. Since 9/11 and the anthrax attacks, the Commissioned Corps Readiness Force has placed increased emphasis on terrorism preparedness training for its volunteers.

Learning from the Experts

Before September 11, courses on terrorism and bioterrorism response were not exactly a staple of most nursing school curricula. Today, of course, it’s a different story, with a growing number of academic institutions incorporating this urgent new subject into their nursing programs.

One of the most unique efforts is under way at St. Louis University School of Nursing, which launched a first-of-its-kind online disaster preparedness certificate program in February. The idea for the program came out of a faculty meeting when professors asked one another, “If we have another 9/11, what are we supposed to do?” recalls assistant professor of nursing Dotti James, RN, PhD.

When nursing school alumna Elsie Roth, RN, MA, BSN, heard about the plan, she suggested that faculty members travel across the world to learn from the experts: Israelis. “Who would know better how to respond to terrorism than them?” she says. Adds James, “In Israel, they’re living with this constantly and take a very pragmatic approach: Get ready for it.”

Roth, a public health nurse who has traveled to Israel many times, volunteered to lead the expedition. As a lifetime member of Hadassah, a women’s organization supporting the Hadassah hospitals in Israel, she worked with her Israeli contacts to set up an in-depth learning program for the St. Louis University faculty at the Henrietta Szold Hadassah Hebrew University School of Nursing and Hadassah Hospitals in Jerusalem. Roth and four faculty members representing the School of Nursing and the School of Public Health spent an intense week learning from local military and public health officials, volunteers and emergency room doctors and nurses.

James says the experience was profound. They learned the technical and systematic methods the Israelis use to respond efficiently to terrorist incidents, such as suicide bombings, and they witnessed the impacts of terrorism on the day-to-day lives of residents and hospital personnel. They watched as health care workers trained new mothers how to put gas masks on their infants.

“The big thing we learned is it can happen here,” James emphasizes. “People are going to turn to us as nurses, and that’s not the time to say, ‘I don’t know what to do.’”

The certificate program requires six core courses plus four courses selected from a menu of 12 electives. The electives include such topics as biological terrorism, social and psychological impacts of disasters, basic epidemiology, and the unique needs of vulnerable populations (such as children, the elderly, people who are incarcerated, people who live in high-rise buildings and immigrants who don’t speak English).

“The Whole Issue is Education”

In addition to the ANA, other nursing professional associations are also responding to the need to prepare nurses to deal with the threat of terrorism. For example, the National Black Nurses Association is offering a full-day Red Cross Disaster Training session at its upcoming 2003 Annual Conference in New Orleans.

The Academy of Medical-Surgical Nurses is adopting a position statement calling for education for nurses on bioterrorism agents, signs and symptoms of exposure to such agents, treatment plans, containment and self-protection. “The whole issue is education, education, education,” says academy president Doris Greggs-McQuilkin, RN, MA, BSN, the first African-American nurse to lead the national organization. The academy is also incorporating a new chapter on disaster planning and bioterrorism into its core curriculum.

Earlier this year, the American Academy of Ambulatory Care Nursing held a special workshop on “Preparing the Nursing Workforce for Bioterrorism” at its recently completed 2003 Annual Conference. “We felt all of our nurses needed to be aware of the risk,” says the academy’s president, Catherine Futch, RN, MN, CNAA, CHE, CHC.

The threat of a bioterrorist attack is so frightening that most people would rather not think about it. But the best way to reduce the public’s fear is to educate them about the challenges and how to respond, Futch asserts. In this context, nurses’ ability to understand other cultures, communicate with diverse populations and provide linguistically competent public health education will be more important than ever, she adds.

Health care systems are still another group that is beginning to address the issue of terrorism response. And they, too, are aware that preparedness information must be easily accessible to patients of all races and ethnicities. For example, after the anthrax scare, Kaiser Permanente, the nation’s largest HMO, made sure it had patient education materials about anthrax available in various different languages.

Gayle Tang, RN, MSN, Kaiser’s national director of multicultural services, believes that planning how to provide culturally and linguistically competent medical care in response to terrorism will be a key issue. The big question, says Tang, who is Chinese American, is: How do we reach all the diverse populations, especially those who don’t speak English? By arming themselves with a strong base of education, knowledge and skills in terrorism preparedness and response, minority nurses can be indispensable leaders in efforts to answer that question.