Current State of National Emergency Preparedness: Implications for the Health Professions Tener Goodwin Veenema PhD MPH MS PhD MPH MS CPNP Associate Professor University of Rochester School of Nursing and d School of Medicine & Dentistry Center for Disaster Medicine and Emergency Preparedness University of Rochester Health Sciences Center President, TenERER Consulting Group, LLC CCHNYS May 4 2008
First things first! Good morning! It is great to be here in White Plains! Every opportunity is a gift. Welcome to our morning together!
U.S. National Preparedness Are We Ready? How prepared are we? ; How prepared do we need to be? and How do we prioritize efforts to close the gap? The emphasis is on developing appropriate levels of capabilities to address a wide range of terrorist attacks and disaster scenarios. Working --together as a single, integrated system when the need arises.
Overview Current state of National Emergency Preparedness- progress since 9/11 ($7 billion in federal funds over past 6 years) Implications for the profession of Nursing and other health care disciplines All-Hazards approach to planning Challenges to workforce preparedness The ReadyRN:: Making Every Nurse a Prepared Nurse Initiative
9/11
Anthrax October 2001
Current State of National Preparedness: Are we Ready? Disasters happen every day somewhere in the nation Are we more prepared today for a disaster or major public health emergency? How do you measure national preparedness? How prepared are our today s nurses to respond to a major disaster or bioterrorist event? How prepared are our nation s s nurses to respond to any major public health event?
Trust for America s Health Ready or Not? Protecting the Public s Health, Reports issued each December (December 18 2008) 5 th year the report has been issued Major Funding for Biopreparedness through CDC and HRSA 10 key indicators to assess the state s public health emergency preparedness capabilities New indicators are chosen each year Level of preparedness has improved but it is still not where it needs to be www.healthyamericans.org
Trust for America s s Health 2008 State Health Report Cards This is a great resource to locate: The State of your Health (New York) Public Health Preparedness Score Pandemic Influenza Preparedness Public Health Funding Facts
Key Findings Ten states do not have adequate plans to distribute emergency vaccines, antidotes, and medicalsupplies from the Strategic National Stockpile. Twenty-one states do not have statutes that allow for adequate liability protection for healthcare volunteers during emergencies. Twelve states do not have a disease surveillance system compatible with the CDC National Electronic Disease Surveillance System. Seven states have not purchased any portion of their federally-subsidized or unsubsidized antivirals to use during a pandemic flu. Six states and D.C. lack sufficient capabilities to test for biological threats.
Pandemic Flu Planning Challenges remain Goal to slow the spread Shortage 100,000 nurses 40% no show Don t t count on the feds
What is all-hazards preparedness and types of events are hospitals and other health care organizations concerned with? What are the implications of lack of preparedness for health care organizations and the individuals they employ?
What does All Hazards Preparedness look like? Rapid detection of emergency disease threats Intensive investigative abilities to quickly diagnose a rising disease threat or intentional attack Surge capacity for mass events inclusing adequate facilities, equipment, supplies, and trained health professional Mass containment strategies Streamlined and effective communications
What will it take to achieve basic levels of preparedness? Leadership, Planning and Coordination, a well established chain of command across agencies An expert and fully-staffed workforce: highly trained and adequate numbers of public health professionals Modernized technology Pre-planned, safety-first first rapid emergency response capabilities & precautions (to mitigate potential harm to communities & people)
Bioterrorism Anthrax Botulism Plague Smallpox Tularemia Viral Hemorrhagic Fevers (Anthrax in PA Feb. 2006, and Plague September 2006)
Chemical/HAZMAT Emergencies Chemical terrorism Industrial/Hazardous Waste TICs & TIMs Toxic releases/environmental disasters Transportation accidents
Radiation Emergencies Nuclear power plant emergencies Industrial radiation releases Radiation Dispersal Devices (RDDs or dirty bombs ) Nuclear level weapons
Natural Disasters such as California Wind-whipped wildfires have tormented Southern California from San Diego to suburban Los Angeles, causing deaths, destroying homes and threatening thousands more. wildfires
2004, 2005 Hurricane Seasons NOTEWORTHY RECORDS OF THE 2005 ATLANTIC HURRICANE SEASON 26 Named Storms (previous record: 21 in 1933) 13 Hurricanes (previous record: 12 in 1969) Four major hurricanes hitting the U.S. (previous record: three in 2004) Three Category 5 Hurricanes (previous record: two in 1960 and 1961) Two-Year Consecutive Total of Hurricanes: 24 (previous record: 21 in 1886-87) 87)
2007 Public health threats Salmonella in peanut butter XDR-TB Massive recall of toys from China Cummulative bird flu deaths among humans tops 200 E Coli in hamburger meat prompts largest recall MRSA 94000 infections and over 19000 deaths
Station Club Fire Band Great White ignited pyrotechnics inside small nightclub Owners had installed foam on all the walls 100 people died in less that 30 minutes
Naturally Emerging Infectious Disease SARS Avian Influenza Influenza West Nile Virus Monkeypox Nipah Virus Return of the Dinosaurs (Tuberculosis, Pertussis)
Identify Challenges Confusion re: what is a disaster v. MCI v. public health emergency Apathy effect (it will never happen here or to me) Regional variations in level of preparedness Regional Interpretations of risk Multiple scenarios to prepare for Lack of knowledge regarding the unique clinical & leadership components of disaster response
NYC Hazards Building Collapses/Explosions Carbon Monoxide Coastal Storms & Hurricanes Disease Outbreaks & Biological Events Earthquakes Extreme Heat Fire Flooding HazMats,, Chemical Spills & Radiation Severe Weather Thoughts on Terrorism Utilities Disruptions Winter Weather
New York State Disasters 2006 Flooding 2003 & 2005 Power Outages 2003 Ice Storm 2002 Earthquake, Snowstorm 1996 Blizzard
Implications for Nurses and Other Health Care Providers Administrative/Policy: creating safe environments for response Altered Standards for Clinical Practice Education Research: Evidence Based Practice
Hurricane Katrina The federal health response to Hurricane Katrina received D grade
Mandates for Preparedness States, Hospitals, public health departments, community health organizations, and all other organizations that employ nurses, (and academic institutions) are faced with a major dilemma: How do they develop a nursing workforce that is Knowledgeable? Ready to respond to any type of disaster or public health emergency? Willing to respond to any type of event?
NATIONAL PLANNING SCENARIOS Created for Use in National, Federal, State, and Local Homeland Security Preparedness Activities Scenario 1: Nuclear Detonation 10-Kiloton Improvised Nuclear Device Scenario 2: Biological Attack Aerosol Anthrax Scenario 3: Biological Disease Outbreak Pandemic Influenza Scenario 4: Biological Attack Plague Scenario 5: Chemical Attack Blister Agent Scenario 6: Chemical Attack Toxic Industrial Chemicals Scenario 7: Chemical Attack Nerve Agent Scenario 8: Chemical Attack Chlorine Tank Explosion Scenario 9: Natural Disaster- Major Earthquake Scenario 10: Natural Disaster Major Hurricane Scenario 11: Radiological Attack Radiological Dispersal Devices Scenario 12: Explosives Attack Bombing Using Improvised Explosive Devices Scenario 13: Biological Attack Food Contamination Scenario 14: Biological Attack Foreign Animal Disease (Foot and Mouth Disease) Scenario 15: Cyber Attack
Surge Capacity In 2006, the federal government granted $474,210000. to improve communication, conduct training and to stockpile supplies and equipment. Healthcare system s ability to manage a sudden or rapidly progressive influx of patients at a given point in time Nurses are critical to surge capacity and need to know how to participate in a response.
What s s unique about disaster Triage (greatest good nursing? Triage (greatest good ) Allocation of Scarce Resources Decontamination Use of PPE (Critical for Nurses, eg.. SARS) Event Management ICS Crisis Leadership & Managerial Decision Making
What covers ALL of these hazards Prepares nurses for all types of disasters CBRNE events Mass casualty events Natural disasters EID including avian and pandemic flu Public health emergencies Environmental disasters and topics?
ReadyRN Disaster Nursing
Purpose Research-based: Immediate answers to nurses five most frequently asked questions How do I keep myself safe? How do I care for my patients? How do I manage this event? Who can I call? How do I keep my family safe?
ReadyRN Content Enhances nurses sense of clinical competence and personal safety Current, valid, and reliable Evidence-based where available Competency-based Based on our Federal standards (DHS, CDC) NRF NIMS and ICS National Scenarios
Course 25 critical modules Each module includes Overview Key messages Competency-based learning objectives Case studies (relate to the NRP scenarios) Metric for evaluation Image rich
ReadyRN Course Can be modified as needed to target organizational needs/ nursing subspecialties Selected modules can be used for JIT training E-learning course available whenever needed (ACCESS) SCORM, sole source for gov
Sample Strategy for Preparing Pediatric Nurses: Essentials of Disaster Planning Disaster management Disaster Triage Unique needs of children during disasters and public health emergencies Management of the Psychosocial Effects of Disasters
Challenges are Opportunities! What are your preparedness challenges? Are you worried about surge capacity? Are you concerned about worker no- show/absenteeism during a infectious disease? How prepared is your community health center for these events?
Pandemic Influenza Preparedness is Key! ReadyRN is being used as part of state and organizational Pandemic Influenza Preparedness Plans across the country
National Strategy for Pandemic Influenza Early detection and response is critcal Coordination of international containment and rapid response Prepare to implement layered border measures Develop rapid diagnostic tests (LRN Network) Create ability to care for large numbers of ill Stockpile critical supplies and medications Maintain essential gov services and buisiness sustainability
Sample Strategy Pandemic Influenza Biological Agents of Concern Early Detection & Surveillance of Biological Events Emerging Infectious Diseases Design and Implementation of Mass Vaccination Clinics Personal/Family Disaster Plan
Value Proposition for Health Care Organizations Several existing mandates for emergency preparedness Joint Commission mandates hospital emergency preparedness State and local health departments as part of county plans and mutual aid agreements Helps achieve CDC and HRSA preparedness indicators
Value Proposition for Health Care Organizations This is PRIMARY education for 99% of nurses Hospital risk management requirements Performance improvement/achievement of quality goals (Magnet, etc). Promotes IOM 2008 goals for patient safety ReadyRN is a patient safety initiative!
Workforce Challenge for Health Care Systems Willingness to respond to a disaster or major public health emergency is dependent upon the clinician s: Sense of clinical competence Perception of personal safety Confidence in the safety of family and significant others
Important for Health Care Organizations Business sustainability Maintenance of appropriate staffing levels no matter what event occurs (contains personal/family disaster plan) Ability to achieve nurse sensitive PFP metrics Demonstrates evidence of organizational commitment to Nurse Safety Total Solution for nursing workforce preparedness ReadyRN ensures that your nursing workforce is knowledgeable, clinically competent, and willing to come to work.
Most important HRSA and CDC Grant Funding available to license curriculum Helps States achieve DHS goals Helps hospitals achieve EP workforce development goals
Value Proposition to Nurse Enhances sense of clinical competence Greater understanding of role in a disaster Increased perception of personal safety Greater ability to care for patients, and their own families Course Credit or Continuing Education Units Total Solution for personal preparedness ReadyRN ensures nurses that they will be knowledgeable, clinically competent, and able to advocate for their personal safety.
ReadyRN is endorsed by the Red Cross Awareness level course Customized to conform to restricted practice parameters 20 modules Password protected website
Thank you! Tener Goodwin Veenema, PhD, MPH, MS, CPNP International expert in disaster nursing and emergency preparedness Associate Professor of Clinical Nursing and Assistant Professor of Emergency Medicine, University of Rochester Award-winning winning textbook RWJ Executive Fellowship Consultant to the American Red Cross and other federal agencies
Disaster Nursing and Emergency Preparedness Tener Goodwin Veenema PhD, MPH, MS, CPNP, FNAP 2004 Robert Wood Johnson Executive Nurse Fellowship Project