Recent mass shootings in Orlando and Dallas have the nation feeling scared and stressed. As a nurse, do you know what you would do during a tragedy like these or a natural disaster such as a hurricane or tornado?
DailyNurse.com spoke with experienced Emergency Department (ED) and trauma nurses to find out.
What’s the Plan?
“Know your hospital’s Disaster Plan and what you are expected to do,” says C. Lynne Grief, PhD, RN, CEN, TCRN, vice president of trauma and burn services at Blake Medical Center in Brandenton, Florida. Having worked in the ED with many patients from a motor vehicle accident, a tornado, and a situation in which 6 critically ill patients went into cardiac arrest upon arrival to the ED (having overdosed on a toxic substance at the same time), Grief has a lot of experience in working during a crisis.
“Oftentimes your instinct is to come into the hospital and report for work when you hear about a disaster,” says Grief, but this can cause trouble. “During the tornado, we found that this created problems because there were too many people for the initial wave of activity—which added to the chaos—and not enough for the second wave of activity or the follow-up in the following days because everyone reported for the first wave,” she explains.
In addition, while nurses may be credentialed and verified to work in one particular hospital or facility, the one that’s dealing with the influx of patients won’t know that. “Even in times of crisis, it is the hospital’s responsibility to know that all the practitioners providing care in its facility are licensed and credentialed to do so,” says Grief. (Some states ask nurses when they renew their licenses if they would be willing to help in a disaster. Contact your local state board of nursing for more information.)
If you aren’t able to help at the hospital, Grief says that local blood banks are usually overwhelmed and can use help, but call them first before showing up. She also suggests calling the hospital’s Human Resources Department to see if they need assistance.
“Our hospital has a system that sends electronic alerts out to its staff and is able to use this to request off-duty staff to report. In times of disaster, many ED nurses will actually call in to the ‘charge nurse’ to see if they are needed,” says Susan Boyle, MSN, APRN, AGNP-C, CEN, CCRN, an emergency nurse at Morristown Medical Center (a part of Atlantic Health Systems) in Morristown, New Jersey.
Boyle has experienced working in multiple snow emergencies, motor vehicle crashes, and other incidents involving large numbers of casualties. She also worked during Hurricanes Sandy and Irene. “Part of disaster management involves obtaining and allocating resources—such as staff members—and sending them to the areas in need,” she says. “The ED is a large family, and when disaster strikes, it is amazing how we can all pull together to ensure we continue to provide the best care to our patient population. Hurricane Sandy posed a unique series of challenges to staff who were dealing with lack of power, lack of fuel, and their own family crises. Yet they were able to put this in perspective and show up to care for others in need.”
Maria Calloway, RN, MBA, DNP, Ne-BC, chief nursing officer at Central Florida Regional Hospital in Sanford, Florida says that she learned how to remain calm in traumatic situations from a doctor she worked with. “I remember a trauma surgeon who taught us to breathe normally and remain focused. He stressed to us that changes in breathing can lead to less oxygen in your brain and may reduce the brain’s blood supply by 20-30 percent,” she explains. “He, like many other physician and nurse mentors in my career, taught me to focus on the patients and saving their lives. The patient becomes the center of what you do and why you do it.”
“One of the innate attributes of an ED nurse is the ability to remain calm when disaster strikes. We are trained to keep our focus on what we need to do; there is little time to allow emotion to get in the way, and we just get on with the job,” says Boyle. “Our goal, at this point, is to keep our patients alive, to stabilize them, to prevent further injury, and to play our part as a cog in a large trauma team.”
Boyle remembers many years ago that when she would wait on the roof of the facility for a helicopter to arrive with a trauma victim, she would have butterflies in her stomach, wondering whether she would be able to handle the unknown emergency. Today, those butterflies are long gone, but oftentimes when she’s in the car ride home from work, she finally takes a breath and processes all that went on during her day.
In the Event
If you find yourself in the middle of the actual disaster, there are ways to stay calm and to help. First, make sure that you don’t become part of the problem and require assistance yourself. Get yourself away from harm’s way, say both Boyle and Calloway. Boyle adds to be sure to stay out of the way of the paramedics, firefighters, and police who respond to the scene.
“Call 911 immediately, even if you think someone else has already called,” says Michael Pidgeon, BSN, RN, CCRN, a staff nurse in the trauma/surgical ICU at Henry Ford Hospital in Detroit, Michigan. “This ensures that the emergency response system is activated and that help is on the way.”
Once you are convinced that the scene is safe, Boyle says to put your feelings on the backburner because you need to help others who may be in severe physical and emotional distress. “All nurses know how to provide first aid. They know CPR. They can provide the basics. Oftentimes, people want someone to ‘take charge’ and tell them what to do—apply pressure here, keep this person calm, hold this child, et cetera. Nurses are very adept at doing this,” says Grief.
“Take a deep breath, and go into your professional mode. You will be surprised at how much you know and have picked up along the way. You may feel that your skillset is inadequate because you are not an ED or trauma nurse, but you have great communication skills and injury management skills. You may be the most skilled person at the scene,” says Grief. “Your biggest mistake will be doubting yourself, which may result in inertia. Don’t panic when you’re not in your usual setting. Your skillset comes with you, no matter where you are.”
Finally, care for yourself. Pidgeon suggests getting debriefed after and use the resources available to deal with the consequences of the event. “The experience is traumatic, which can affect us, as nurses, and we need to recognize that,” he says. “We cannot take care of others if we do not take care of ourselves.”