Disaster Response Nursing: Could You Stay Alive for 72 Hours?
Preparing people and facilities for large-scale emergency events
Interview with Kathy Stevenson, RN, BSN, Children's Hospital Los Angeles
Please share with us a synopsis of your nursing career.
As of this year, I’ve worked at Children’s Hospital Los Angeles for 30 years. I began my nursing career in high school by participating in a career path course that resulted in my earning a certification as a CNA. Attending Mount St. Mary’s in Los Angeles, I earned my BSN. I had a very positive clinical rotation at Children’s Hospital as a student nurse and was lucky enough to be hired as a new grad.
Over three decades, I’ve been a staff nurse on the toddler unit, assistant nurse manager on the infant unit and served as house supervisor at Children’s Hospital for about 20 years.
I have also served on the Children’s Emergency Preparedness Committee. We receive federal funding that assists hospitals to prepare for disasters. I’m now also the manager of the Children’s Hospital Los Angeles Disaster Resource Center, coordinating with other L.A. County entities in preparing for a variety of disasters. Having been a member of the Emergency Preparedness Committee and a house supervisor, I’ve always understood the bigger picture in terms of disaster preparedness.
Tell us a little more about emergency preparedness in L.A. County.
Funding comes from the Office of the Assistant Secretary and Response (ASPR) for the Hospital Preparedness Program (HPP). Each state is awarded money every year from the federal government. Four cities have been identified as high-risk: New York, Chicago, L.A. and Washington, D.C.
Thirteen hospitals in the area — out of approximately 100 total in L.A. County — have taken the lead in developing a disaster resource center program and Children’s Hospital Los Angeles is the Pediatric Disaster Resource Center. We are a regionally located disaster resource center working with area hospitals in county-wide planning and preparation for large-scale events.
We have a large cache of medical supplies, pharmaceuticals and equipment and we’re ready for most any event. The relationships that have been built between the different hospitals and agencies are very important. Everyone knows one another and we have a good working knowledge of the strengths and resources offered by each individual facility.
What types of events are you prepared for?
We use what is called an “all hazards approach”: looking at what disasters have in common, including communication, logistics, command structure and the hierarchy of authority. Being nimble is essential since we work in a world of hypotheticals and theoreticals. No two disasters are the same and we need to consider the lessons that are learned each time.
Regarding specific types of events, we are prepared for natural disasters such as earthquakes and wildfires; active shooter and hostile work environment scenarios; and chemical, biological and nuclear disasters, including the ability to conduct wide-scale decontamination.
We have worked to develop mass fatality plans, medical mass care plans and family information center plans, including schools and other facilities. In terms of mental health for staff and victims, we are prepared to offer support during and following any large-scale event.
Crucially, we’ve developed a “pediatric surge plan” to help hospitals deal with an event that includes a disproportionate number of child victims. We’ve examined methods for harnessing the ability of hospitals to respond, offered additional training for non-pediatric hospital staff and discussed strategies so that EMS personnel can distribute pediatric patients to appropriately prepared facilities throughout the county.
What do you find most challenging about your work in disaster relief?
Just when we think we have it solved, something new happens or we realize that we need to practice a certain type of drill or potential scenario. With emergency preparedness, it’s difficult to persuade people who are very busy in their daily lives to think about preparedness. Probably fewer than 25 percent of people are properly prepared for disasters and keeping emergency preparedness at the top of people’s minds is a challenge since few people believe that something bad may actually happen.
We like to provide staff with enough training for them to have their homes and families prepared for various scenarios. If our staff are not prepared at home and secure that their loved ones know what to do in case of emergency, they won’t be able to be focused at work when we need them most.
Having said that, on the third Thursday of every October, we have a statewide drill known as “The Shakeout.” In this well-publicized event, people around the state practice what they will need to do during an actual earthquake. Many local businesses are involved as well as most aspects of the public sector.
What about your work feeds your spirit and helps you to come back each day?
I think I’ve tried to be a problem-solver throughout my career and emergency preparedness is always about trying to solve problems. The more information we can give people and the more we practice, the more nimble we can be when something actually happens.
During large- and small-scale drills, we utilize Boy Scouts and Girl Scouts as “victims” and I use these opportunities as teaching moments. It’s great to see the light bulb turn on in their young heads and the ripple effect of that knowledge can be enormous. Even if an interaction results in one person or family putting together an emergency preparedness kit, I feel so good about it.
Hospitals are earnestly preparing for how they can play a part in preparedness and our many opportunities for teaching and learning is what keeps me coming back and making a difference.
As a nurse, I find that nursing knowledge always prepares us to problem-solve and come up with solutions and plans. Thus, disaster response and nursing are a wonderful combination of skills.
Is there something you’d like to share to illustrate the positive ripple effect of your work?
There have been a number of our staff who have chosen to join volunteer disaster relief teams in other region of the United States as well as in other countries. Our staff members feel competent in rising to the occasion — both locally and beyond L.A. — and I’m proud that we have such giving people in our midst.
How do you debrief from the stress? How do you care for yourself?
The disaster resource center has worked to provide our staff with training in ongoing personal care. We have also covered issues around what healthcare professionals can do to help debrief and release stress from participating in a large-scale event.
When an individual is impacted by a traumatic event, it’s important for them to identify on whom they can rely for support. They also need to be aware of the feelings and sensations that are signs of stress and the need to practice good self-care.
Many of our staff members work in stressful situations with very ill children on a daily basis, so we look closely at self-care as a facility. We have a great employee assistance program for our staff, including highly trained chaplains and social workers. Our facility offers frequent staff debriefing and self-care opportunities throughout the year, not just related to a specific event.
As for me personally, I have a 1-year-old Australian Shepherd and we go hiking a lot. She can put a smile on my face even when I’m feeling down. Spending time with friends and family, enjoying life and reaching for those things that decrease stress are important practices. Constantly building resiliency is very important for nurses. You never know what’s going to touch you or cause you stress. You need a robust toolbox to reach into when you need it.
How can someone living in Southern California get involved in emergency preparedness?
First, begin preparing at home with your own family. Think about the what-ifs and hypotheticals and visit websites like www.ready.gov for ideas and suggestions. Also, don’t be afraid to volunteer to help in your community or with preparedness drills in your facility or workplace.
Those who live in Los Angeles County can visit the L.A. County Emergency Medical Services website, ems.dhs.lacounty.gov, for local information. Nurses, healthcare professionals and laypeople can join the Medical Reserve Corps and participate in drills and other activities.
What characteristics do you look for in your disaster relief colleagues?
I look for people who like to be problem-solvers and who can remain calm and think clearly under stress. It’s also important to be able to think outside the box while not knowing what you’ll be confronted with at any given time. I also appreciate people who constantly want to learn and share the ability and desire to adjust as things shift and change.
Disaster relief professionals need to have themselves and their families prepared for anything. Personal preparedness and having your own plan for how you’ll respond helps people be able to keep their cool during an event.
If a nurse were interested in exploring this specialized area of nursing, what would you recommend they do?
Again, being personally prepared is crucial. You can also learn how hospitals act during disasters by starting at your own place of employment and learning how your facility is itself prepared for any eventuality. You can work with your facility’s emergency preparedness team and begin to understand the plans and logistics involved.
What special certifications or training are required?
There is training and certification in hospital incident command that would be appropriate for a health professional who would like to explore this as a career path. Additional trainings include hazardous materials first receiver and various trainings in decontamination procedures.
The Hospital Association of Southern California and the California Hospital Association conduct trainings for health professionals on situations including but not limited to chemical events, radiological events and active shooter scenarios.
Do you have future career plans?
I continue to be open to opportunities, and I continue to learn and evolve as a nurse and a professional. I like to think of myself as a person who is open new experiences, and I’m always willing to grow.
Could You Survive for 72 Hours?
by Carole Jakucs, RN, BSN, PHN
Nurses respond to medical emergencies both on and off duty. We provide everything from minor treatments to major lifesaving measures such as chest compressions for cardiac arrest. Our employers even train us in basic fire suppression.
Even so, are we prepared to be self-sufficient for a minimum of 72 hours in our homes with no power or running water? Do we equip our homes and vehicles with the necessary supplies so we can evacuate in a moment’s notice in the event of a raging wildfire? Have we empowered our children and/or significant others to hold down the fort if we are unable to leave work during a major disaster? If not, now is the time to create a personal and family disaster plan.
I grew up in Northern Ohio. The weather on the Great Lakes can be extreme, with brutally cold winters and hot humid summers. I learned how to survive snowstorms and the summer brew of thunderstorms and tornado warnings. Once I moved to California, my concern about volatile weather ceased until I experienced my first earthquake and discovered that I needed to increase my knowledge of earthquake preparedness.
Luckily, major earthquakes are rare, but as time passed, the possibilities of major hurricanes or acts of terrorism also reared their ugly heads. It became clear to me that no matter where one lives, being prepared for disasters is key to survival. Read on for ways to get started.
WHILE AT WORK
In the event of earthquakes, storms, power outages or other major disasters, follow the established protocols at your place of employment with regards to your responses in order to ensure patient and personal safety. The appropriate strategies may vary depending on what unit you work in, what type of disaster is at hand and the specific circumstances.
FOR YOUR HOME
Keep your emergency supplies in a central location and make sure all household members know where the supplies are. Take inventory of and rotate your supplies on a regular basis so your water and food are fresh and equipment is operable.
Water: Keep a supply of bottled or bagged water on hand in the recommended amount of 1 gallon per person per day for a minimum of three days’ use.
Food: Maintain a supply of nuts, granola bars and other types of nonperishable foods that can sustain you in an emergency. You can also purchase military-style meals ready to eat (MREs) at a local surplus store or online. MREs have a long shelf life and some taste surprisingly good.
Pets: Don’t forget about your pets. Keep extra water and an emergency supply of pet food (and any medicines your pets require) on hand with your other emergency supplies.
Power: Consider purchasing an emergency generator, but remember that it needs a fuel source to operate. If you buy a generator, read the instructions in advance so you have enough fuel on hand to keep the generator running.
Flashlights: Ensure that you have at least one flashlight per person and extra batteries. Be sure to check the batteries regularly and replace any battery that’s past its expiration date.
Gas and water shutoffs: Know where your gas and water shutoff valves are located and learn how to shut them and under what circumstances. Keep the tool(s) you need to shut off the gas and water in a central location along with your other supplies.
Fire extinguisher: Purchase one that is classified as ABC, which will extinguish three types of fires. Ensure that all household members of an appropriate age know how to use the extinguisher and make sure it is recharged and inspected as needed.
Legal documents: Any vital documents should be stored in a waterproof, fireproof container that is easy to grab if you need to evacuate your home quickly.
Escape routes: Plan accordingly for various types of emergencies. Keep a full tank of fuel in all vehicles.
Communications: Have a battery- or crank-operated radio on hand for emergencies so you can stay connected to news/safety announcements if your power is out. Try to keep cellphones charged at all times. Prearrange plans to contact and reunite with family members if you’re separated. Remember, local phone lines may not work and local cellular networks may be overloaded, so agree on an out-of-state contact with whom all family members can check in.
Special Needs: If you have children, care for older relatives or anyone with special needs or have special medical requirements yourself, make sure you incorporate extra supplies and/or medicine and equipment into your plan. Keep your first aid and CPR skills up to date and encourage any willing family and friends to get trained too.
FOR YOUR CAR
Here are some supplies to have in your car at all times: A first aid kit, a seatbelt cutter, bottled water, granola bars or nuts, at least one blanket, an extra sweatshirt, walking shoes, a cellphone charger, a rain poncho and a usable, properly inflated spare tire.
For more information, visit www.emergency.cdc.gov.
The Unthinkable: An Armed Intruder
An active shooter can appear at work or any public place. According to the Department of Homeland Security (DHS), the following are some steps you can take to increase your chance of survival: First, evacuate the area and escape if you can. The second option is to hide, lock and barricade the door and avoid possible lines of fire. If the first two options fail and you find yourself face to face with the attacker, the third and last option is to act aggressively and use whatever is at hand in your environment as a weapon to throw at or hit the attacker. If you are at work, follow the guidelines laid out by your employer to protect your patients and yourself.
For more information, see the Department of Homeland Security website: www.dhs.gov/active-shooter-preparedness.
“Will I be punished for my good deed?”
California’s Good Samaritan Laws
by Amy Semmel, Attorney at Law
What are your obligations and rights if while off duty you find yourself in an emergency situation where your skills could be lifesaving?
First, if you’re off duty, you are under no legal obligation to render assistance. Doing nothing will eliminate any risk of liability. However, if you’re faced with an emergency, especially a life-threatening one, you may feel a personal and moral obligation to help. In situations like that, California’s so-called “Good Samaritan” laws may provide legal protection.
To encourage medical care providers like nurses and doctors to offer assistance during a crisis, the law provides immunity from liability when the following conditions apply:
• A first responder provides medical or non-medical care at the scene of an emergency.
• The first responder provides those services in good faith and not for compensation.
It is important to understand that this immunity applies only to designated first responders and only at the scene of an emergency. However, if you meet those criteria, you can be reasonably confident that you will not be punished for your good deed.
This information is a general explanation of the law and is not intended to serve as legal advice. If you require legal advice regarding any specific situation, you should consult an attorney.