1. Chaffee, Mary MS, RN, FAAN

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The horror of September 11, 2001, had barely receded from public consciousness when Hurricane Katrina decimated New Orleans and the Gulf coast. Those of us at a safe distance watched the televised images like drivers slowing at a highway accident, thinking, "That could have been me, my family, my hospital."


While disasters, natural and otherwise, are unpredictable, they occur with regularity. Hurricanes Katrina (2005), Andrew (1992), and Camille (1969) and the Great New England Hurricane of 1938; the Great Chicago Fire (1871), the San Francisco earthquake (1906), and the Oakland wildfires (1991); airline crashes, train wrecks, chemical explosions, terror attacks: all have taken scores of lives and caused billions of dollars in damage.


Disaster victims naturally turn to hospitals and other health care facilities for help. But disasters can cripple these facilities. Between 1971 and 1999, there were 275 hospital evacuations in the United States, nearly half of them forced by natural disaster, according to a study by Sternberg and colleagues in the August 2004 issue of Prehospital and Disaster Medicine. The federal government's Disaster Medical Assistance Teams under the command of the Federal Emergency Management Agency do not always arrive as quickly as needed, leaving much of the rescue work to local health care and emergency workers and ordinary citizens-like those who pulled the injured out of their cars after the Northridge earthquake in greater Los Angeles in 1994.


Communities must prepare long before disaster strikes, and-nurses should be in the forefront.


Hospital preparedness requires the collaboration of executives, managers, clinicians, security staff, engineers-representatives of every department. It cannot be relegated to volunteers or consultants or achieved through online training courses (a widespread practice). The Joint Commission on the Accreditation of Healthcare Organizations requires health care facilities to maintain an emergency management plan, orient staff to disaster duties, and run drills. But these are minimum standards only. Staff training and frequent practice are essential.


Hospital preparedness cannot be relegated to consultants.

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You don't have to wait for your employer to lead the way. Read your organization's disaster plan. Think now about what you'd do if the disaster left you homeless or without transportation. Does your hospital have a plan to provide shelter for you and your family or otherwise help with family responsibilities? Some nurses have indicated they will not report for duty if they have obligations to children, elderly parents, or pets. This raises staffing issues that should be addressed. A hospital on the hurricane-prone Florida coast, for example, exempts employees with elderly dependents or young children from disaster response. Finally, make sure you have a personal disaster plan, including backup supplies of medication and other essentials, and a way of contacting family members.


Disaster planning at every level must be realistic. Spending a lot of staff time discussing how to comfortably add patients to a 32-bed nursing unit will pay scant dividends if a disaster results in 300 injured evacuees in your ED.


As advocates for the vulnerable, nurses must ask tough questions. Some of mine are:


* When almost all terror attacks involve bombings rather than biological weapons, why don't we invest more to strengthen trauma systems and mass casualty care?


* Why isn't there more federal support of emergency preparedness in hospitals?


* Why aren't more citizens trained to be basic responders? Hurricane Katrina showed how a disaster can cripple government response.



Studying the lessons of history will help health care organizations prepare and guide policymakers to minimize harm to people and property. With the leadership of nurses, our communities and our nation can be better prepared for the next disaster.