In this paper, I will review and implement recommendations based on the findings of the Agency for Health Care Research and Quality (AHRQ) regarding the training of hospital staff to respond to a mass casualty incident (MCI). I will give examples and situations that can affect the effectiveness of proper training and responses to a traumatic event in our city, county, state, or country. For years, hospitals have contemplated the possibility of a mass casualty incident (MCI). Federal agencies planning and responding to these events have determined that it would be overwhelming and catastrophic to any community.
The resources would not be sufficient to absorb the needs and requirements for help. These events can be naturally occurring or manmade, for example, hurricane season and tornado season in Texas can be predicted with accuracy. In the West coast, we have constant planning and preparation for the next big earthquake even though we do not know with accuracy when it would be. During hurricane Katrina, we had an excellent opportunity to witness how prepared a city is, and how hospitals can easily be overwhelmed by a massive influx of patients. Examples can be given worldwide, but for the purpose of simplicity we will not elaborate further.
Never before have we experienced more threats than in the past few years starting from the Oklahoma City bombing and the 911 attacks as the most horrific examples to site. More and more we have seen our fears become our realities and our vulnerabilities, and this is what has made us rethink our strategies and training for proper response to chemical, radiological, or biological threats. Findings The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that hospitals implement and test proper hospital response training twice a year.
My hospital, BAMC, a military hospital, has complied with the training and has made significant contributions to the evolution and preparedness in response to a potential or actual event. The military has always been an integral part in training and preparation in regards to logistics and coordination of available resources, but even the best trained or better equipped hospitals cannot compensate for the impact it has on its employees, particularly nurses. Nurses take part and are an important aspect of training and preparation, and they are essential in the response to a crisis or trauma.
Working in the emergency department, I often question myself as to how is it that we can train and prepare every year for a mass casualty incident (MCI) when I can see how easily we get overrun and in total disarray. Our hospital is currently capable of taking up to four major traumas all at the same time, but the reality is that even under the best staffed days we get overwhelmed, resourcing quickly to diversion of Emergency Medical Service (EMS) to other hospitals when we have reached maximum capacity.
If training then is to prepare us and allow us to be well equipped with the necessary knowledge to perform, why is it that we struggle under small real life case scenarios? The response has to be once again in the level of preparation that each individual nurse takes to be ready to be able to function under very stressful environment. The nurse can be well prepared for future events by performing after action reviews (AAR), which is primordial in determining the stressors and the potential solutions to the problems encountered after each event.
Disaster drills are beneficial in the effectiveness of command and control, communication, triage, patient flow, security response, and the roles each practitioner must perform. Recommendations Hospital drills and disaster planning are key and instrumental to make the nurse familiar with his/ her role, as well as the role of all the providers of care and first responders. Proper coordination and adequate allocation of resources are essential. The nurse can be instrumental in his/her flexibility and ability to adapt to different roles under extremely chaotic circumstances. Also, nurses are important for the delegation of tasks and
coordination of duties to be taken to stabilize the emergency department for the proper movement of patients arriving and departing. The nurse plays an integral role in the transporting of patient, triage, and treatment of the injured. Properly identifying those who are very critical (expectant, life threatening), and those who are stable and can still function (broken bones, laceration, psychological issues) allows the provider to render the proper and efficient care. The nurse needs to have clear communication with the rest of the staff at every level of the disaster event in order to function and coordinate efficiently.
Good documentation needs to be implemented. Nurses need to remain creative in finding ways to document what has been done to a patient with regards of his or her care. In a war zone, we can document key components of patient treatment on the uniforms of soldiers, and the same can be done with civilian population in the absence of computers or charting for short periods of time. Another important aspect is the transport of first aid equipment and supplies as soon as the disaster is identified, including body bags, stretchers, wheelchairs, crutches, splints, IV solutions, blood products, antibiotics, and plenty of analgesics and narcotics.
Keeping an adequate number of chaplains, counselors, and security is imperative for the emergency department to maintain order under the chaos and stress. Summary In conclusion, the registered nurse needs to be ever vigilant of the realities of our current situations of the world. Today, more than ever with ongoing climate changes and unpredictable massive storms, tornados, earthquakes, and the impending threats created by man, we are always at risk for an (MCI).
Keeping a good understanding of the preparation and the steps to take, and knowing his or her role the nurse can be reassured that he/she will be ready for the unpredictable and often unthinkable. References Training of Hospital Staff to Respond to a Mass Casualty Incident Evidence Reports/Technology Assessments, No. 95 Rockville (MD): Agency for Healthcare Research and Quality (US); July 2004 http://angel03. gcu. edu/section/default. asp? id=705202 Mass Casualty Incident (MCI) St. John West Shore Hospital, MCI Overview http://www. emsconedonline. com/pdfs/EMT-Mass%20Casualty%20Incident-an%20overview-Trauma. pdf