Evacuation of a rural community hospital: lessons learned from an unplanned event.

A credible bomb threat forced the complete evacuation of a rural community hospital. An Incident Command System was implemented, and all 46 patients were temporarily transported and maintained at 2 local sites. They were returned to the hospital approximately 24 hours later. Only one patient experienced a complication possibly associated with the evacuation. This article discusses pertinent strategies and considerations involved in the planning and execution of a rural hospital evacuation. It further highlights the role of the emergency department medical and nursing staff throughout the evacuation process.     

Managing mild casualties in mass-casualty incidents: lessons learned from an aborted terrorist attack

INTRODUCTION: Mildly injured and "worried well" patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties. METHODS: Data were collected during and after the event, using patient records and formal debriefings. They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission. RESULTS: A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint. During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently. Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%). Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine. CONCLUSIONS: Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to appear in two phases. In the first phase, the rate of admission is expected to be higher. Due to the high incidence of anxiety and other stress-related phenomena, many mildly injured patients will require psychiatric evaluation. In the case of a bombing attack, many of the victims must be evaluated by an otolaryngologist.     

Violence in a pediatric emergency department: lessons learned from one experience

A multitude of forces influence the probability of violence in an emergency department, but none impact as directly as the skilled response of the emergency nurse. It is important not to overlook the availability of security and law enforcement, but it may be equally important for nurses to take appropriate steps toward preventing or solving such problems with a minimum of physical and emotional pain for all concerned. With time and practice, incidents of violence can be replaced with opportunities for growth and healing.     

Large-scale urban disaster drill involving an explosion: lessons learned by an academic medical center.

Disaster drills are an effective way to test a hospital's preparedness for real-life disasters, but an extensive amount of coordination and time is necessary to host a successful drill with a large number of victims. The lessons learned in this drill include a number of planning, education, orientation, and follow-up issues. It is not realistic to believe that a drill can be perfectly planned and practiced; therefore each drill provides another opportunity to improve on past experience.     

Managing mass casualties in Israel.

The author relates her experiences as an observer at an Israeli mass casualty simulated exercise in a general hospital. Israeli people, who have seen their country engaged in several major wars over the last 40 years and who live with the potential for terrorist atrocity as a daily threat, treat such exercises with great seriousness. The scale and realistic nature of the exercise was impressive, and while such activities may not be directly translatable to a British situation, the energy, commitment and systematic approach of the Israeli personnel are qualities which British hospital and military staff could adopt.     

The Volendam fire: lessons learned from disaster research

INTRODUCTION: After the Volendam fire, a multidisciplinary, integral evaluation, called the Medical Evaluation of the Disaster in Volendam (MERV), was established. This article is a discussion of disaster research methodology. It describes the organizational framework of this project and the methodological problems. METHODS: A scientific steering group consisting of members from three hospitals prepared and guided the project. A research team wrote the final study protocol and performed the study. The project was funded by the Ministry of Health. The study protocol had a modular design in which each of the modules focused on one specific area or location. The main questions for each location were: (1) which treatment protocols were used; (2) what was the condition of the patient; and (3) was medical care provided according to existing protocols. After the fire, 241 victims were treated in hospitals; they all were included in the study. Most of the victims had burn injuries, and approximately one-third suffered from inhalation injury. All hospitals and ambulance services involved were visited in order to collect data, and interviewers obtained additional information. The government helped obtain permission for data-collection in three of the hospitals. Over 1,200 items of information about each patient and > 200,000 total items were collected. During data processing, the data were re-organized, categorized, and presented in a uniform and consistent style. A cross-sectional site analysis and a longitudinal patient analysis were conducted. This was facilitated by the use of several sub-databases. The modular approach made it possible to obtain a complete overview of the medical care provided. The project team was guided by a multidisciplinary steering group and the research was performed by a research team. This enabled the research team to focus on the scientific aspects. CONCLUSION: The evaluation of the Volendam fire indicates that a project approach with a modular design is effective for the analysis of complex incidents. The use of several sub-databases makes it easy to combine findings and conduct cross-sectional and longitudinal analyses. The government played an important role in the funding and support of the project. To limit and structure data collection and analysis, a pilot study based on several predefined main questions should be conducted. The questions then can be specified further based on the availability of data.     

An emergency department shooting of a prisoner/patient under guard: lessons learned

When an ED prisoner/patient was shot, the unfortunate incident offered a number of lessons, even for a busy, seasoned emergency department with good security. These lessons, not the least of which was to think twice before removing both handcuffs, are worth sharing.     

Patient satisfaction with triage nursing in a rural hospital emergency department

This study examined what relationships or differences exist between patient and nurse characteristics, satisfaction with triage nurse caring behaviors, general satisfaction with the triage nurse, and intent to return to a rural hospital emergency department (ED). The ED, located at a 401-bed teaching hospital in a small southern city, averages 28,000 visits annually. Samples of ED nurses (N = 11) and ED patients (N = 65) were asked to respond to demographic forms and the Consumer Emergency Care Satisfaction Scale (CECSS) Adapted. Findings indicated that the nurse's acuity rating and the patient's perception of condition had a positive relationship. The patient's perception of condition, patient satisfaction, and caring satisfaction were predictors of intent to return. When patients perceived themselves as seriously ill or injured, they expressed less intent to return to that ED.     

Addressing hospital nurses' fear of abandonment in a bioterrorism emergency.

Most hospitals' disaster plans are extensive and effective at establishing an incident command center, directing material and personnel resources, and triaging patients. However, few organizations have assessed caregivers' needs and fears related to disaster response. When nurses have been interviewed on this topic, findings indicated complex concerns involving fear of loss (e.g., loss of order in their work environment, loss of safe work conditions, loss of freedom to come and go at will, and loss of trust in their hospital's commitment to their best interest). The sobering result of anticipating these losses is fear of abandonment. The purpose of this article is to address factors identified by hospital-based nurses that contribute to their fears of abandonment in a bioterrorism emergency. Hospitals that choose to respond to these concerns will exemplify best practice toward care of the community and care of their own nurses.     

Managing acute psychotic disorders in an emergency department

Emergency departments are frequently faced with managing agitated patients experiencing episodes of acute psychosis. Effective, efficient handling of these conditions is crucial in maintaining a safe environment. This article reviews the definition of the term psychosis. This article also considers the possible causes of psychosis, including differential diagnoses, and outlines treatment options and nursing interventions available in the emergency department.     

Meeting the challenge of bioterrorism: lessons learned from West Nile virus and anthrax

Hospital emergency departments (EDs) and ambulatory clinics may be the first to recognize illness related to a bioterrorist event. Every health-care institution must develop a weapons-of-mass- destruction (WMD) preparedness plan as part of its all-hazards disaster planning. As part of an all-hazards disaster plan, WMD preparedness should use the incident-command model to insure the required chain of command for effectively coordinating activities between hospital departments and external agencies. Preparedness for bioterrorism poses unique challenges. In the event of a biological attack, the hospital infection control staff and administration must already have in place the means to communicate with local and state public health agencies, the Centers for Disease Control and Prevention (CDC), local law-enforcement agencies, and the Federal Bureau of Investigation (FBI). Local and regional planners must consider how to coordinate the responses of emergency medical services (EMS), police, and fire departments with healthcare providers and the news media. Most hospitals are ill equipped to deal with a catastrophic event caused by WMD. The burden of responding to such events will fall initially on ED physicians and staff members. The severity of such an incident might be mitigated with careful planning, training and education. The responses of one hospital network to the outbreak of West Nile virus and, more recently, to the threat of anthrax, are presented as guides for bioterrorism preparedness.     

Implementing a Web-based information resource at an inner-city community church: lessons learned

The objective of this project was to develop and implement electronic access to HIV/AIDS information resources at Glide Memorial Church in San Francisco, CA. This involved developing tailored Web-based access to the relevant information for the Glide Clinic patients. In addition, the project deployed workstations in 2 clinic areas and provided support to clinic patients as they learned to access the information resources. This article describes the experience with information retrieval in a clinic setting for underserved patients, including lessons learned, effective strategies, and anecdotes of effect on patients. Required nursing informatics competencies in this particular area are also addressed.     

Managing a combined burn trauma disaster in the post-9/11 world: lessons learned from the 2003 West Pharmaceutical plant explosion

At 1:37 pm on January 29, 2003, an explosion occurred at the West Pharmaceutical chemical plant in Kinston, North Carolina. The explosion killed three people at the scene and resulted in more than 30 admissions to area hospitals. The disaster resulted in 10 critically ill burn patients, who were all intubated with inhalation injuries, many with combined burn and trauma injuries. All 10 critically injured patients were admitted to a tertiary care facility 100 miles away with both a Level I trauma center and a verified burn center. Ultimately, 7 of 10 patients survived (a mortality rate of 30%), and none were transferred to another trauma or burn center. This article analyzes the unique challenges that combined burn and trauma patients present during a disaster, critically examines the response to this disaster, describes lessons learned, and presents recommendations that may improve the response to such disasters in the future.     

Managing osteoporosis in a rural community

Managing long-term conditions, such as osteoporosis in a rural community, presents particular challenges. This article describes how a specialist service identified patients at high risk of fragility fracture and raised awareness of bone health.