Disaster Nursing and Emergency Preparedness - Springer Publishing

Chapter 1 Essentials of Disaster Planning 17
Hazardous Materials Disaster Planning
Every industrialized nation is heavily reliant on chemicals.
The United States is no exception; it produces,
stores, and transports large quantities of toxic industrial
agents. In fact, hazardous materials are present in every
sector of American society and represent a unique and
significant threat to civilians, the military, and health
care workers both in the field and in the hospital emergency
department. Situations involving hazardous materials
suggest a need for additional planning efforts
(Levintin & Siegelson, 1996, 2002). The chemical industry
and the U.S. government have been making substantial
efforts since 9/11 to increase security preparedness.
Industry is carrying out joint assessments with
the Federal Bureau of Investigation; the Environmental
Protection Agency; Coast Guard; FEMA; the Bureau of
Alcohol, Tobacco and Firearms; and the Office of Homeland
Security (Institute of Medicine, 2002). In the United
States, the Superfund Amendment and Reauthorization
Act requires that all hazardous materials manufactured,
stored, or transported by local industry that could affect
the surrounding community be identified and reported
to health officials. Gasoline and liquid petroleum gas
are the most common hazardous materials, but other
potential hazards include chlorine, ammonia, and explosives.
Situations involving relocation of nuclear
waste materials also pose a considerable risk to the
communities involved. Material safety data sheets standardize
the method of communicating relevant information
about each material—including its toxicity, flammability,
and known acute and chronic health effects—
and can be used as part of the hazard identification
process.
Clinically, the removal of solid or liquid chemical
agents from exposed individuals is the first step
in preventing serious injury or death. Civilian hazmat
teams generally have basic decontamination plans in
place, though proficiency may vary widely (Institute of
Medicine, 1999). Few teams are staffed, trained, and
equipped for mass decontamination. Hospitals need to
be prepared to decontaminate patients, despite plans
that call for field decontamination of patients prior to
transport. Currently, few hospitals in the United States
are prepared to manage this type of disaster. During a
hazmat accident, the victims often ignore the rules of
the disaster plan by seeking out the nearest hospital for
medical care, regardless of that institution’s capabilities.
If health care providers rush to the aid of contaminated
individuals without taking proper precautions
(e.g., donning PPE), they may become contaminated—
the newest victims (Levitin & Siegelson, 1996). Because
mismanagement of a hazmat incident can turn a contained
accident into a disaster involving the entire community,
disaster planning initiatives must incorporate
victim decontamination and PPE into the planning process
(Levitin & Siegelson, 1996, 2002). A detailed discussion
of hazmat and patient decontamination is found
in chapter 26.
PROFESSIONAL NURSING MANDATE
Caring for patients and the opportunity to save lives
is what professional nursing is all about, and disaster
events provide nurses with an opportunity to do both.
According to the American Nurses Association (ANA),
“the aim of nursing actions is to assist patients, families
and communities to improve, correct or adjust to physical,
emotional, psychosocial, spiritual, cultural, and environmental
conditions for which they seek help” and
definitions of nursing have evolved to acknowledge six
essential features of professional nursing (ANA, 2003,
pp. 1–5):
■ Provision of a caring relationship that facilitates
health and healing.
■ Attention to the range of human experiences and responses
to health and illness within the physical and
social environments.
■ Integration of objective data with knowledge gained
from an appreciation of the patient or group’s subjective
experience.
■ Application of scientific knowledge to the processes
of diagnosis and treatment through the use of judgment
and critical thinking.
■ Advancement of professional nursing knowledge
through scholarly inquiry.
■ Influence on social and public policy to promote social
justice.
All nurses should have an awareness of the basic
life cycle of disasters, the health consequences associated
with the major events, and a framework to support
the necessary assessment and response efforts. Several
nursing organizations have focused on the need for
improved disaster nursing preparation. The ANA, the
Emergency Nurses Association (see Case Study 11.1),
and the Association for Professionals in Infection Control
and Epidemiology have each issued position statements
regarding the need for nurses to advance their
disaster knowledge and preparedness skills. In addition,
the National Student Nurses Association also recognized
the need to prepare itself for practice in disaster settings
(see Case Study 1.2). Although not all nurses will want
to become “disaster” nurses, it is imperative that each
nurse acquire a knowledge base and minimum set of
skills to enable them to plan for and respond to a disaster
in a timely and appropriate manner.