Disaster management requires planning, improvising, and

evaluating - Editorial - health care facilities

AORN Journal, April, 2002 by Brenda S. Gregory Dawes

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Disasters never can be considered routine. In health care settings throughout the country, we try to
prepare for external and internal disasters (eg, tornado, hurricane, bomb threat, fire) with as much
routine information as we possibly can. New employee orientations and annual education reviews require
that we address disaster management information, including safety practices, equipment use, policies,
and procedures. Personnel attend the mandatory offerings, and, at the time of a disaster, we hope that
enough information is fresh so that everyone will know what to do and when to take action.
When a disaster occurs, health care settings experience everything except the routine. In 2001, not only
did we experience a mass casualty in September and repercussions associated with terrorist activities, but
Tropical Storm Allison, a totally different type of disaster, devastated parts of Houston and tested
emergency preparedness in the area, including that of a major health care setting. In this issue of the
AORN Journal, the author of "Responding to a fire at a pediatric hospital" (page 793) discusses a
manmade disaster and how staff members used the facility's disaster preparedness plan. The article
describes unexpected circumstances that resulted in plan deviations that proved effective during the
event. Disasters of any type force us to revisit our practices, which is something many health care settings
have been doing during the past several months.
REAL LIFE CHALLENGES
A multidepartment approach to disaster planning is effective to meet the broad scope of needs; however,
circumstances and approaches differ for each type of disaster and individual departments, so integrating
efforts, services, available personnel, and activities (eg, instrument availability, procedures in progress)
challenges everyone. When floods ravaged a Houston pediatric hospital, health care facilities in close
proximity supported patient care in unexpected ways.
Of the 42 facilities affected, Texas Children's Hospital had minimal water damage and could continue
providing patient care, but personnel were not isolated to the challenges. Creative approaches to triage
and transport were implemented because the medical center depends on tunnels for underground
movement of people and supplies. When the tunnels filled with water, unexpected changes became
cumbersome. Activities such as transporting immobile patients on ventilator support through stairwells
and triaging patient care from area settings were unplanned and required considerable coordination. The
mere fact that a baby was delivered at the Houston Department of Veterans Affairs Medical Center proves
that you cannot begin to prepare for events that might occur.
Disaster reviews are resulting in unexpected upgrades and training programs in some health care settings
that already are extended financially, although some settings are finding they do not require extensive
changes. Carol Orr, RN, BSN, MHR, CNOR, director nursing surgical services, St Jude Children's Research
Hospital, Memphis, reviewed disaster plans as a result of events in 2001, but she found the hospital did

not need major changes. Upon reviewing current policies, she found that they were appropriate to
manage untoward circumstances. Specifically, the hospital has a high level of security on campus, and a
lock down policy is in effect.
Ann Altaffer, RN, director of perioperative services at Bristol Hospital, Conn, says that in her setting, they
recognized the need to improve decisions about managing procedures during disasters. Staff members
plan to develop an algorithm or decision tree to use during future events.
Antonette Robles, RN, MSN, CNA, a director at Children's National Medical Center, Washington, DC, notes
that ongoing program development changed the facility's mass casualty plans. They developed a code
purple designation, which includes a plan for exposed and nonexposed patients and personnel, along with
a plan for securing the building in the event of biological agent exposure, chemical response, or nuclear
warfare. The facility has purchased a decontamination tent and established supply availability for each
employee. As in other settings, several drills have been held, and emergency room personnel are receiving
extensive training.
Stephen Knoll, RN, MA, CRNA, vice president of surgical services at Trinity Mother Frances Health System,
Tyler, Tex, also has been involved actively in revising his facility's policies and procedures to include germ
warfare and purchasing equipment to manage unexpected circumstances. He explains that an outcome of
the attention to disaster management is increased vigilance in all areas. Specifically, staff members are
evaluating information technology and plans for safeguarding computers and patient data in the event of a
disaster.
PLANNING, IMPROVISING, AND EVALUATING
Recent events and a commitment to patients, employees, and the community have shifted the mindset of
many caregivers that disaster preparedness is a once-a-year event. Major disasters can take on a life of
their own, so being prepared for the unexpected and unplanned is the only way to improve circumstances.
Take time to evaluate and associate what was done in a previous situation, and compare it to what might
be beneficial in different circumstances. Ask yourself "what if?" It is important for everyone to think about
the smallest details in extreme circumstances so the necessary resources are available. When drills are
initiated, think about what the real circumstances would be and how situations might be managed. It is
easy to plan for a disaster when you have power and people, but when a disaster hits, the lights go out
and skeleton staffing is in place, so necessary resources may change.
Although disaster planning efforts usually are initiated at the administrative level, it is important for the
members of each department and shift to determine priorities, as they will become the responsible
parties. Caregivers can benefit from peer experiences, but many resources also now are available through
the Internet, including checklists, information, and updates from web sites maintained by such
organizations as the Joint Commission on Accreditation of Healthcare Organizations, the American Medical
Association, and the Centers for Disease Control and Prevention.
ATTITUDE DETERMINES OUTCOMES
Never assume that time spent planning and evaluating will be wasted. Man hours spent preparing for the
year 2000 (Y2K) were not a useless effort if you consider the lessons caregivers learned that can be and

have been applied to other events. Talk to others who have experienced disasters and their aftermath to
learn their lessons and prepare for the unexpected. Take disaster planning and education offerings
seriously so when an internal or external disaster occurs, your facility's disaster management plan can be
implemented with total commitment and a minimum of confusion. Finally, assume responsibility to plan for
the routine, but consider how you could improvise for extraordinary circumstances. Anyone who has
experienced a hurricane, tornado, flood, fire, bomb threat, or other disaster knows that our attitude
toward difficult circumstances will determine the outcome. Our combined brainpower and willingness to
share the lessons learned can help us as perioperative nurses prepare for and manage disasters, and also
realize how to improve our circumstances.

BRENDA S. GREGORY DAWES

RN, MSN, CNOR
EDITOR
Editor's note: You con help others learn about disaster preparedness by sharing your stories and lessons
learned. Contact the editor, AORN Journal, 2170 S Parker Rd, Suite 300, Denver, CO 80231-5711, (888)
376-3244, e-mail BSGD@aol.com or access the author guidelines at http: //www.aorn.org.
COPYRIGHT 2002 Association of Operating Room Nurses, Inc.
COPYRIGHT 2002 Gale Group