Like so many other hospital workers near the sites of the terrorist attacks on September 11, 2001, Maureen DeSena, RN, waited for patients. She'd been at home with her two-year-old when her husband called to say that a plane had hit the Pentagon, and as an emergency nurse at Virginia Hospital Center in Arlington she knew that she was expected to act as a first responder for any disaster there. Despite being seven months pregnant, she didn't hesitate to go in.
About 35 or 40 patients arrived, said DeSena (who's now an ED nurse at Inova Emergency Care Center in Reston, Virginia), and about 10 were transferred to a burn unit. "That first golden hour of trauma was very busy. It was, oddly, very organized. I remember our nursing director standing in the ambulance bay, saying, 'Get a patient, go in, do what needs to be done.'"
A decade later, as the nation honors the nearly 3,000 lives lost in the attacks and recalls the heroic efforts of responders, nurses are taking stock. Several nurses spoke with AJN recently and offered their perspectives, and although they expressed different opinions on how well nursing is prepared for a mass-casualty event, all agreed that the profession has made great strides in the years since 9/11.
Captain Lynn A. Slepski, PhD, RN, CCNS, a senior public health advisor at the Office of Intelligence, Security, and Emergency Response in the Office of the Secretary of Transportation, has been deeply immersed in disaster preparedness since 9/11. That morning, as an employee of the U.S. Public Health Service (USPHS), she helped to place on notice 1,600 USPHS officers and all 72 teams of the National Disaster Medical System. Since then, she has worked in various agencies, and despite what she sees as insufficient progress in the training of health care workers, she remains optimistic about the nation's ability to respond to disaster.
"Since 9/11, we've completely remade what was the federal response plan into what is now known as the National Response Framework, a far more comprehensive and descriptive document," she said. "Agencies now know who's in charge, who's in a support role, and what's supposed to happen."
Figure. CAPTAIN LYNN...Image Tools
Mickie Brown, RN, deputy nurse manager at the World Trade Center Medical Monitoring and Treatment Program in New York City, which is funded by the National Institute for Occupational Safety and Health, has been teaching stress reduction techniques to workers and volunteers made ill by their work at Ground Zero. Brown said that in 2008 nearly half of patients receiving treatment had new or exacerbated cases of asthma, 78% had rhinosinusitis, and 57% had gastroesophageal reflux disease; also, about 900 patients receive mental health services for conditions such as posttraumatic stress disorder and major depression.
Nurses are involved in both monitoring and treatment, Brown said; they take occupational health histories, discuss preventive health, and teach the correct use of devices such as nebulizers.
Figure. Mickie Brown...Image Tools
"Patients want to understand what's going on in their bodies, particularly as it relates to stress," she said. "With a simple tool like diaphragmatic breathing to calm the nervous system, you've given them a gift." Certified in mind–body medicine, Brown has received approval from New York City's Mount Sinai Medical Center to conduct a study on whether an eight-week stress-management protocol will decrease patients' use of asthma medications; other outcomes measured will include worry levels and sleep quality. (The World Trade Center program has been funded annually since 2002, but the James Zadroga 9/11 Health and Compensation Act of 2010 went into effect on July 1 and ensures continued funding through 2015 for the World Trade Centers Clinical Centers of Excellence, of which Mount Sinai is a member, with more than $4 billion in federal funding going to treatment and compensation of victims.)
Rear Admiral Ann R. Knebel, DNSc, RN, FAAN, deputy director for preparedness planning at the Office of the Assistant Secretary for Preparedness and Response, a part of the U.S. Department of Health and Human Services, spent 10 days at Ground Zero in September 2001. As a commissioned officer in the USPHS, she gave first aid to the workers there—a life-changing experience, she said. She now oversees a staff of 60 people who bridge federal, state, and local preparedness efforts.
She sees nurses as instrumental to this work—even though nurses themselves don't always acknowledge the centrality of their role. "Nurses sometimes underestimate what they have to offer," she said. "They need to understand what they'll have to offer when the next catastrophic event strikes," and unfortunately, she added, there is likely to be one.
Figure. REAR ADMIRAL...Image Tools
Joan M. Stanley, PhD, CRNP, FAAN, senior director of education policy at the American Association of Colleges of Nursing, chaired the Nursing Emergency Preparedness Education Coalition at Vanderbilt University's School of Nursing when it released its 2003 recommended "educational competencies" for RNs responding to mass-casualty events (see http://bit.ly/n9HvrD). Proficiency in assessment and communication, as well as in wound care and the use of personal protective equipment, were among the disaster-preparedness skills identified as essential for all nurses. Although the coalition lost its federal funding in 2010, Stanley said that perhaps because groups have finally pulled together to define basic competencies, training and education can now take place at the local level.
Theresa M. Valiga, EdD, RN, ANEF, FAAN, professor and director, Institute for Educational Excellence at the Duke University School of Nursing, was in her office at the National League for Nursing, four blocks south of Ground Zero, on the morning of 9/11. Without power, the building was evacuated. Valiga recalled a poignant encounter that took place on the stairs as she walked down from the 33rd floor: a woman held a roll of saturated paper towels to use to help with breathing in the dusty air outside, and each person took only one.
Figure. JOAN M. STAN...Image Tools
"People caring about each other," Valiga said. "That still stays with me."—Joy Jacobson
© 2011 Lippincott Williams & Wilkins, Inc.