Many of us remember our exact whereabouts on September 11, 2001, and our disbelief and confusion upon learning that terrorists had flown planes into the World Trade Center and the Pentagon. Throughout the decade since—one characterized by a broad range of natural and man-made disasters—our nation's nurses have been at the forefront of response efforts. Catastrophic events have included hurricanes, tsunamis, earthquakes, emerging infectious diseases such as severe acute respiratory syndrome and H1N1 influenza; most recently, a massive earthquake off the coast of Japan triggered a deadly tsunami that damaged a nuclear power plant, resulting in radiation leaks. At this juncture, the nursing profession would be well served by taking stock of its collective level of preparedness. Why? Because a nursing workforce that's prepared for any type of disaster is one that will be better able to protect patients, families, and communities, as well as its own members.
National preparedness has progressed considerably during the past decade. Hospitals now routinely have operations plans for both internal and external disasters, and disaster drills have become commonplace. Flexible staffing plans have been established and include such measures as the reallocation of nurses to the ED or to emergency annexes or mobile satellite hospitals during a mass casualty surge.
In the wake of any catastrophic event, communities need nurses who will respond quickly and are clinically competent to provide safe, appropriate care. Perhaps the most important lesson we've learned is that, during a disaster, priorities change. The objective shifts from providing high-quality, individualized care to saving as many lives as possible. Before the 9/11 attacks and Hurricane Katrina, many of us had only imagined what such events would be like. Now we know what these kinds of events will demand of us—and the gap between where we currently stand and where we need to be is clear. Much work remains to be done to ensure that all members of our profession possess the knowledge and skills necessary to respond appropriately to any type of disaster. We must engender a broad-based professional culture of excellence, both in disaster nursing care and in health systems' management of catastrophic events.
Disaster nursing education has been buoyed by the release of several national reports and initiatives that provide a blueprint for advancing preparedness. For example, in September 2008, the U.S. Government Accountability Office called on the Federal Emergency Management Agency to update the role of the American Red Cross in responding to emergencies. In response, the American Red Cross has recently revised its Disaster Health Services Concept of Operations to overcome scope-of-practice limitations and accommodate nurse-managed shelters nationwide.
In 2009, the Institute of Medicine (IOM) issued a report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, that assisted public health officials, health care facilities, and professionals in developing "policies and protocols for standards of care in disasters where resources are scarce." Disaster situations often create ethical and legal conundrums for responders and may raise personal and professional liability issues. The implementation of crisis standards of care can help guide decision making and ensure that fairness, equity, and transparency are maintained.
Last October, the National Commission on Children and Disasters delivered its 2010 Report to the President and Congress, proposing broad recommendations to address children's physical, mental, and psychosocial needs during disasters. And in the same month, the IOM released The Future of Nursing: Leading Change, Advancing Health, a report that made the case for nursing's transformative roles.
Despite these encouraging developments, controversy persists over defining competencies for disaster nursing; and many nurses still lack the repertoire of skills they'll need in a crisis. We have made progress, surely, but more remains to be done.