Johnstone, & Turale, S. (2014) states, it is a frightening realization that the Emergency Departments (EDs) have not managed to take care of emergency patients, even on the normal days. This raises the question whether this same departments can manage the large scale disaster. In health care setting, the definition of disaster extends far than just an event that injures large number of individuals, to its financial, legal ethical and heath care implications. Critical analysis of these perspectives, as provided in this paper can offer the relevant institutions such as Emergency Nurses Association (ENA), Division of Injury Response (DIR) and National Center for Injury Prevention and Control (NCIPC) best strategies for disaster management.
While protecting the working personnel comes in as the priority, Johnstone, & Turale, S. (2014) notes that many hospitals, almost 70% lack special facilities and equipments for protecting the ED staff. The implication of this is that the ED nurses can fall victims of chemical and biological attack. These authors are also concerned that many of ED personnel are not properly decontaminated before arriving in the disaster scene. The ED personnel are also subject to secondary contamination, after the victims arrive in their health facilities. The secondary risk can be presented if the healthcare providers inhale the contaminated fumes from the exhale of the patients. In another circumstance, which is most probable, the ED personnel gets contaminated from the toxic products carried on the victims’hair, clothing or the skin.
As Johnstone, & Turale, S. (2014) presents the Acute Respiratory Syndrome in China and Sarin attacks in Tokyo as two major examples demonstrating the difficulties in protecting the health professionals, even in small outbreaks. Many health professionals became victims of the two disasters, because of what Redman terms as the lack of adequate equipments and negative pressure rooms. But there is also a major concern that provision of the adequate number of negative pressure rooms and equipments are not the solely strategies, instead, they are just a part of the solution. As Mills states, there must be substantial training in containment, decontamination and more especially the disaster recognition procedures if the we have to protect the ED personnel.
Implications to Ethical and Patient Care
Redman, Mills & Casella (2015) is concerned about the ethical expectations, challenges and their implications to patient care at large. He notes that, many disasters give rise to conflict in ethical expectations. Along this line he presents the evidence from a case of earthquake strike, in Sichuan, China which led to massive loss of about 69, 227 people and 374, 643 injured. From this disaster, it was noted that the triage nurses have limited time to gather all the information required from the patient. This explains why all the emergency departments performed quick assessment and actions based on protocols. As you many understand, but conflicting, the Emergency Nurses Association (ENA) advocates actions to be based on patients’preference. In reference to the above case, the disaster gave rise to one of the most disputed ethical issue in nursing professional that, nurses observed protocols in serving the victims. The implication of this was that some victims, with chances of surviving died while the nurses attend the less injured patients. Since then, the ENA, in their code of ethics, expects the ED nurses to exercise beneficence. This simply means taking an objective view when the conflict exists the patient care.
Financial Implications and Reputation of the Hospital
As the terrorism cases continues to be witnessed across all the continents, specialized training in the clinical department has been emphasized. This can be confirmed from CDC survey, conducted in the year 2013 indicating that, at least one of the staff have received the above training in all the 49% of the total hospitals. However, only limited studies have focused on the cost of managing disaster in the health care setting. Revisiting the issue specialized training, cost is the major impeding factor when training ED personnel. Almost 61 % of the hospitals, as noted by Redman, Mills & Casella (2015) have reported inadequate funding to help ED personnel cover full attendance costs (tuition, time off, travel). For instance, it costs $ 3, 000 per hour to train Nuclear, Chemical and Biological ED personnel in Pittsburgh Medical Centre
Johnstone, M. J., & Turale, S. (2014). Nurses’ experiences of ethical preparedness for public health emergencies and healthcare disasters: a systematic review of qualitative evidence.? Nursing & health sciences,? 16(1), 67-77 Usher, K., Redman-MacLaren, M. L., Mills, J., West, C., Casella, E., Hapsari, E. D., … & Amy, Y. Z. (2015). Strengthening and preparing: enhancing nursing research for disaster management.? Nurse education in practice,? 15(1), 68-74. https://www.nap.edu/read/11621/chapter/9#281