It was just before 11:00 AM on February 28, 2001, when the cafe where I planned to have lunch began to shake violently. Recognizing what was happening, I dove under a sturdy table. After what seemed like an interminably long time (but was really only 40 seconds), the quake ended. That's when I found myself in an eerily quiet room. I was the only person left inside because every other customer, cook, and waiter had run out of the building. When I emerged through the open front door, I was greeted by the sight of tilted telephone poles with swaying lines, cars stopped (but askew) on the streets, broken sidewalks and bricks that had come off the buildings, and hundreds of people milling around. Next to some of them was a downed, live electric wire. Incredibly, no one (that I could see) had been injured by the wires, upended concrete, or flying bricks. I remember wondering how it could be (in a region expecting at least one devastating earthquake) that I seemed to be the only one who reacted in a commonly taught and prescribed manner.
Then it dawned on me: Perhaps, no one else on that street even knew what he or she should do when the ground becomes unstable. I had an advantage that most people don't. I have been prepared for physical and health emergencies for my entire professional life. In the Army, and then the Army National Guard, I learned to set up our various combat support (field) hospitals as quickly as possible. I participated in frequent drills, utilizing moulaged soldiers as victims of everything from natural disasters to enemy-inflicted wounds. (I was trained and got pretty good at actually doing the moulage makeup before the drills, too. My children thought it was hilarious when I gathered interesting sticks and other objects to use for making pretend wounds on our drill victims.) We drilled day and night, even riding around in jeeps and military ambulances with our night vision goggles on, seeking victims who might be hidden from view in rubble or among the forest trees. In addition, as a civilian nurse leader, I took part in both internal hospital and community disaster drills, learning first how to protect ourselves (hence the almost instinctual diving under the table reaction) and then to care for both individual victims and populations.
Many nurses have this same advantage. Our hospitals or other institutions have educated and drilled us to respond to community crises. We have emergency call lists, arrangements for volunteers to operate CB equipment stored in a hall closet somewhere, paper forms to use when computers go down, plans to allow staff (and often their families) to sleep in the hospital, and designated roles for leaders and staff members working on units, in departments, or in a command center. Despite this, the articles in this edition underscore the fact that, as a whole health care system, we really are not as ready as we need to be.
On the other hand, we sometimes think we are more ready than we are. When the horror and national tragedy (forever to be known as 9-11) happened, I was a civilian nurse executive on the West Coast and also a National Guard member. The Guard went on alert, prepared to go wherever we were ordered and needed, in a coordinated fashion. (In the end, we were not deployed.) At the same time, a number of well-meaning nurses and nurse leaders in my civilian hospital came to tell me (separately) that they were taking "emergency leave" from the hospital so they could fly to New York City to give care to the injured there. In response to my probing questions about these plans, they admitted that they did not have a New York Nursing license, they would not be going as part of an organized group (like the Red Cross or a Disaster Relief Group), and they didn't really know anyone in New York. They didn't know who they would "report to" when they arrived. They simply wanted to "go there" to "give support." I'm sure they thought I was heartless when I denied the emergency leave, both because they were needed in their own jobs and community and (more pertinent) because, after the attack, New York City did not need unorganized individual people who were untrained in disaster mitigation, even nurses, to descend and add to the chaos there.
The authors included in this edition share both experiences and plans for nurses and their teams to be better equipped for future natural or man-made disasters. Their articles are a gift to each of us as we anticipate and proactively prepare for the crises that will happen in our communities. By being proactive, we will all be more able to respond when what-we-hope-and-pray-will-not-happen does happen. As a profession, and as individual professionals and leaders, we owe it to all of our stakeholders to be as prepared as possible ... not just so we jump under the table instead of running into the streets but so we can mitigate more suffering and save more lives.
Thank you for choosing to lead,
-Kathleen D. Sanford, DBA, RN, FACHE, FAAN
Editor-in-Chief
Nursing Administration Quarterly