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Training for disaster

A simulation of a chemical spill accident allows students in the UM School of Nursing and Health Studies to hone their skills

Triage nurse Mary Peters needed to act quickly. A tractor-trailer had overturned on I-95 in Miami, spilling thousands of gallons of a dangerous chemical onto the roadway.

Simulation: During the mock disaster drill, nurses dressed in hazmat suits decontaminate a patient exposed to a dangerous chemical.

Simulation: During the mock disaster drill, nurses dressed in hazmat suits decontaminate a patient exposed to a dangerous chemical.

Peters knew that in less than five minutes, the first casualties exposed to vapor and fumes from the spill would be arriving at the hospital. She’d have to quickly don a hazmat suit and station herself, along with other nurses, inside a decontamination tent, where the victims would be hosed down and scrubbed before entering the emergency room.

The chaotic scene outside the hospital, though, was making her job difficult, as families and reporters had already started to arrive, demanding information about victims.

Mass-casualty incidents like this one test the skills of the nation’s nursing corps every year.

For Peters, however, this disaster was only a drill, a simulation that was part of a three-day training session designed to teach graduate students in the University of Miami’s School of Nursing and Health Studies how to prepare for and deal with patients who have been exposed to dangerous substances.

Following proper procedures when reacting to a mass-casualty incident “takes so much longer to do than when you just read about it in a manual,” said Valerie Bell, director of simulation for the school’s Nurse Anesthesia Program. “We wanted to give our students the knowledge base to respond to such an incident and experience what it’s really like. We’re making a big push for experiential learning.”

About 17 nurses from Jackson Memorial Hospital’s trauma, intensive care, and operating room units joined the UM students during the training session, which was conducted by experts from the American Nurses Association (ANA) and the International Chemical Workers Union Council.

The training covered everything from how to identify and sanitize patients exposed to hazardous substances to the proper way to don a hazmat suit and set up a triage center and decontamination area.

Donning protective gear before rushing to the aid of chemically exposed patients is critically important for nurses, the ANA’s Holly Carpenter told students during the session’s opening day, citing a 2008 incident in Durango, Colorado, in which a nurse fell gravely ill after she helped a man who showed up at the hospital soaked in unknown chemicals.

Inside the command center, UM nursing student Corey Jago and Jackson Memorial Hospital staff nurse Susan Rodney keep track of the condition of victims arriving for treatment..

Inside the command center, UM nursing student Corey Jago and Jackson Memorial Hospital staff nurse Susan Rodney keep track of the condition of victims arriving for treatment..

But it was the mock disaster drill, held on the final day, that proved to be the highlight of the training.

Dressed in full hazmat gear that made them look more like astronauts than health care workers, teams of nursing students and Jackson nurses set up a triage center on the third floor of UM’s M. Christine Schwartz Center for Nursing and Health Studies, evaluating casualties from the I-95 rollover “accident” as they arrived.

Inside a large decontamination tent, nurses used hoses and sponges to cleanse chemically exposed victims before they were taken by stretcher into the emergency room.

At the incident command center, Jackson staff nurse Susan Rodney and UM nurse practitioner student Corey Jago directed the massive disaster response, tracking the status and condition of patients, issuing press releases, answering questions from the media, and setting up a rumor control hotline.

Among the crises that occurred: An infant had to be intubated and transported to Miami Children’s Hospital and a chemically exposed pregnant female delivered a stillborn fetus.

“The students appreciated the symphony of organized chaos,” Bell said, noting that this was the first training of its kind to be offered at the school.

Peters, a student in the nurse anesthesia program who once helped treat 50 firefighters exposed to a dangerous chemical when she was a health care worker at Houston’s Memorial Hermann Hospital, said the simulation taught her how to “overcome the difficulties you encounter in trying to communicate with team members while dressed in a cumbersome hazmat suit.”

Jago, a U.S. Navy flight nurse who was stationed for 14 months at a medical unit outside Felusia, Iraq, said the simulation taught student nurses how to deal with the confusion that often ensues during a mass-casualty incident. He also stressed the need for more training, saying that many health care workers will likely face such a crisis, a sentiment echoed by the ANA’s Carpenter.

“This isn’t some pie-in-the-sky thing that will never happen,” she told the nurses. “It’s probably something you will run into in your nursing career, especially if your hospital is near an airport, train station, chemical storage facility, or major thoroughfare.”

More than 16,870 air-, highway-, rail-, and marine-related hazardous material accidents occurred in 2008, resulting in 188 injuries and ten fatalities, according to statistics from the U.S. Department of Transportation.

“The most important thing [for nurses] is to know what protective equipment is available and have a disaster preparedness plan,” Carpenter said.

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