New horizons for OR nurses—lessons learned from the World Trade Center attack

AORN Journal,  August, 2003  by Tony Forgione,  Patricia J. Owens,  James P. Lopes,  Susan M. Briggs

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Today's highly skilled perioperative nurses work in an environment of tiled walls, bright lights, and recirculated, dust-free air. What happens when a perioperative nurse is thrust into an austere environment with extremely limited supplies, no electricity, and environmental hazards, such as collapsed buildings and fallen power lines? Nurses from Boston's Massachusetts General Hospital met this challenge when called to assist in New York City on Sept 11, 2001, as members of the National Disaster Medical System (NDMS).

WHAT IS NDMS?

National Disaster Medical System is part of the Federal Disaster Plan. It is a cooperative program combining the efforts of the Department of Health and Human Services, the Department of Defense, the Veteran's Administration, and the Federal Emergency Management Agency with civilian volunteer disaster teams. It is designed to provide quality medical care to victims of a disaster in the areas of triage, initial stabilization, definitive medical care, and evacuation. There are three major components to the NDMS, including

* provision of designated hospital beds in the event of a mass casualty incident,

* disaster medical assistance teams (DMATS), and

* specialty DMATS in the areas of burns, pediatrics, and trauma.

Disaster medical assistance teams are part of the government's multitiered disaster response network. Each team consists of physicians, nurses, emergency medical technicians, paramedics, and logistical personnel. There are more than 50 DMATS in the United States. Level one teams are capable of deploying to a disaster site as a self-sufficient unit within 24 hours. Team members routinely train throughout the year to provide state-of-the-art medical support to disaster victims. A team can expect to be deployed for up to 14 days.

THE CHANGING FACE OF DISASTERS

Traditionally, DMATS have responded to natural disasters, such as hurricanes, floods, and earthquakes. Since the 1980s, however, disasters have taken on a new look. Today, disasters frequently are man-made (ie, terrorist acts). After the terrorist bombings of the US embassies in Nairobi and Tanzania, the US government realized that civilian disaster medical teams might be necessary to augment traditional US assets (eg, the military) in caring for US citizens and host country disaster victims abroad. At the request of the State Department, the Office of Emergency Response called on Massachusetts General Hospital to sponsor the first civilian international medical surgical response team (IMSuRT) capable of responding on a global basis. Currently, Boston has the only functioning, fully deployable IMSuRT. Two other teams presently are in the development stage. The mission of an IMSuRT is to participate in all phases of disaster response, including triage, initial stabilization, definitive medical care, and evacuation.

Deployment of an IMSuRT involves two stages of mobilization. Phase 1 consists of a team of 25 members, including physicians, anesthesia care providers, perioperative nurses, intensive care unit nurses, paramedics, and logistical support personnel. Members must carry their own personal equipment and help carry 48 hours worth of supplies. Phase 2 of an IMSuRT deployment involves the arrival of additional civilian personnel and supplies as needed.

Members of an IMSuRT can supplement an existing medical facility's staff, or they can use a deployable rapid assembly shelter hospital (DRASH) (Figure 1). A DRASH is a stand-alone tent with areas for initial triage and stabilization, two OR beds, and intensive care unit (ICU) beds.

[FIGURE 1 OMITTED]

SEPT 11, 2001

The events of Sept 11, 2001, took the world by surprise. In a matter of minutes, a peaceful New York City morning was reduced to a war zone when passenger planes were turned into weapons of mass destruction by terrorists. During any disaster, the initial response is at the local level. In New York, the first response involved New York City fire, police, and emergency medical services. As the horrifying spectacle escalated and buildings came crashing down, frantic calls were sent for more help. With the collapse of the second tower of the World Trade Center, authorities realized that the number of anticipated casualties could overwhelm their resources. New York City authorities requested activation of the NDMS.

Within hours, disaster teams from Massachusetts, New York, and Rhode Island were activated to respond to New York City. Susan Briggs, MD, a trauma surgeon at Massachusetts General Hospital was the supervising medical officer of the DMAT at that facility. She was informed of the attack when she was in surgery.

Officials of the Office of Emergency Response briefed Dr Briggs to expect a massive number of casualties. With this in mind, she was requested to activate Boston's DMAT, along with the specialty DMATs for burns, pediatrics, and trauma.

Ground Zero, as the World Trade Center site was called, is in the heart of lower Manhattan. This was an ironic twist of fate because the Sept 11 attack precipitated the first deployment of IMSuRT. It never was anticipated that a terrorist attack of this magnitude could occur within the United States.