Here are hot trends in disaster training
Do you care for heart attack patients differently than emergency department (ED) nurses in other cities or regions? If not, shouldn’t the way you manage a disaster be standardized as well? Experts in disaster management agree the answer is yes.
"Just as ACLS [Advanced Cardiac Life Support] protocols have been developed to give the best individual response to a cardiopulmonary arrest, disaster courses are now educating people to respond consistently during a disaster," says Kathryn Perlman, MS, RN, CEN, clinical specialist for the ED at Presbyterian Hospital of Dallas.
At Medical College of Georgia in Augusta and University of Texas Southwest, disaster medicine training courses were developed separately. The two facilities are working together to develop a nationally recognized training course, explains Richard B. Schwartz, MD, FACEP, vice chairman of the department of emergency medicine.
The courses will be titled Basic Disaster Life Support (BDLS) and Advanced Disaster Life Support (ADLS). The course is going through the accreditation process with the Atlanta-based Centers for Disease Control and Prevention, and Schwartz anticipates that a pilot course will be held this fall. Here are current trends in disaster management training:
• Courses combine on-line and hands-on training.
Schwartz explains that the BDLS course will consist of standardized didactic training modules, taught in lecture format, but it also can be completed on the Internet at the student’s own pace. The facility intends to partner with the Augusta-based Center for Total Access, an organization that provides distance learning for the military’s aviation medicine program, he says. The ADLS course will consist of hands-on training with decontamination equipment and a training exercise.
• Simulators are being used.
Schwartz reports that the group intends to work with a regional military reserve training center to utilize its high-fidelity simulators and training mannequins. The simulators cost more than $100,000 apiece and mimic actual patients, including chest and heart sounds, response to medications, and other physiological responses, notes Schwartz. The group also plans to work with a company that provides virtual-reality, computer-generated simulation. "We want to utilize on-line and computer-based training as much as possible," says Schwartz. However, even if simulation is used more extensively, Schwartz predicts that hands-on exercises always will be an integral part of disaster training courses. "It’s hard to simulate putting on a Level B suit and actually going through decontamination procedures," he says.
• An "all-hazards" approach is used.
Courses should present a unified approach for each type of disaster, instead of focusing on only one aspect of disaster management, says Schwartz. "Many of the programs out there are focused on bioterrorism or chemical threats without taking the all-hazards,’ unified approach that the Joint Commission is really encouraging now," he notes.
• Information is being standardized.
Schwartz recommends looking for training that provides standardized disaster management strategies. "It’s very easy to put together a group of speakers and run a disaster course," he says. "It’s different to develop content that is peer-reviewed with a consensus for a national standard."
Just as everyone who knows ACLS is able to respond in the same way to an individual emergency, everyone who is "disaster-trained" can respond in the same way regardless of his or her community of origin, says Perlman. For example, if there is a disaster in Dallas, people coming to help from other communities would be "speaking the same language" as the workers first on the scene, she says.
• Training is based on actual experiences at previous disasters.
The chances of actually using esoteric information is very low, and it’s hard to retain, says D.C. Keyes, MD, MPH, director of the Southwestern Toxicology Training Program in Dallas. Instead, he argues that training should focus on practical information and lessons learned from previous disasters.
That knowledge should be used to prepare for future disasters, says Perlman. "We have a lot of information from the Israelis and from the United Kingdom. Applying that information in a systematic way makes the response more efficient. It increases the chances for the victims to survive," she adds.
Keyes points out that historical anthrax experience differs from the presentation of the recent attacks. "We thought that with anthrax you get sick, get better, then get really sick," he says. "With the new wave of pulmonary anthrax, that didn’t happen. Patients got sick and just kept getting sicker." The idea is to provide health care workers with current information, he emphasizes. "We don’t want to tell you what you already saw on the news," he says. "People want to know about the 21 anthrax cases and what happened to them."
Sources and resources
For more information about disaster education, contact:
• D.C. Keyes, MD, MPH, Director, Southwestern Toxicology Training Program, University of Texas Southwestern Emergency Medicine, 5323 Harry Hines Blvd., Dallas, TX 75390-8579. Telephone: (214) 648-2047. E-mail: [email protected].
• Kathryn Perlman, MS, RN, CEN, Emergency Department, Presbyterian Hospital of Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231-4496. Telephone: (214) 345-6301. Fax: (214) 345-6486. E-mail: [email protected].
• Richard B. Schwartz, MD, FACEP, Vice Chairman, Department of Emergency Medicine, Medical College of Georgia, 1120 15th St., AF2037, Augusta, GA 30912. Telephone: (706) 721-3548. Fax: (706) 721-9081. E-mail: [email protected].
The American Red Cross offers three basic disaster response courses: Introduction to Disaster, Disaster Health Services 1, and Disaster Health Services 2. The training includes an overview of Red Cross disaster response, the roles of government and other organizations, common health and emergency needs, and how nurses support an overall disaster-relief operation. Nurses interested in participating in the free training should contact their local Red Cross chapter, which can be accessed at www.redcross.org by entering your zip code.
West Virginia University has established a Center for Medical Preparedness to promote bioterrorism training, research, and readiness activities in partnership with federal and state government initiatives. The center will partner with the West Virginia Bureau for Public Health to provide training and education on bioterrorism and will offer a federally funded web-based course on hospital emergency management being jointly developed by the center and the Morgantown, WV-based Virtual Medical Campus. The center also will conduct research to assist in bioterrorism preparedness nationwide, with a focus on rural needs. For more information, contact: Center for Medical Preparedness, P.O. Box 9150, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506. Telephone: (304) 293-0259. E-mail: [email protected]. Web: www.wvucmp.org
The International Nursing Coalition for Mass-Casualty Education is a clearinghouse for nurses to prepare for mass-casualty incidents. For more information, contact: Betsy Weiner, PhD, RN, FAAN, Associate Director, INCMCE Coalition, Vanderbilt University School of Nursing, 327B Godchaux Hall, Nashville, TN 37240. Telephone: (615) 322-4639. Fax: (615) 343-8204. E-mail: [email protected]. Web: www.mc.vanderbilt.edu/nursing. Click on "Mass Casualty Education."
The Micromedex BioDex System provides access to electronic information on identification, protection, and treatment of bioterrorism agents for personal computers and hand-held devices. The PDR Guide to Biological and Chemical Warfare Response lists symptoms caused by more than 50 biological and chemical agents, with recommended treatments for conditions induced by each. Bioterrorism and Public Health: An Internet Resource Guide features an extensive listing of web-based resources for biological and chemical terrorism. For more information, call (800) 232-7379 or go to www.thomson-bioterrorism.info.
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