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In addition to a disaster plan to deal with an immediate crisis, health care organizations need to have a secondary disaster plan to deal with the aftershocks of the tragedy, says Eileen Hanley, RN, MBA.
Hanley should know. She manages the supportive care program at St. Vincents Hospital in New York City, the closest trauma center to the World Trade Center.
The supportive care program offers nursing, psychological, social, and spiritual support for people with advanced life-threatening illnesses. In addition to Hanley, the staff include three full-time nurses, two part-time social workers, a part-time nurse, and a part-time chaplain.
Since the tragedy of the World Trade Center attacks, the St. Vincents staff have been dealing with the emotional traumas suffered by people who had loved ones in the twin towers, emergency workers, and more recently, hospital staff.
"In my experience, everyone — whether they’re a hospital, a home care agency, or any other health care organization — should have a secondary plan that goes into effect after a disaster of this magnitude," she says.
Her words were echoed by the Case Management Society of America (CMSA) in Little Rock, AR, which sent out a special mailing urging local case management chapters, particularly those in the New York, northern New Jersey and Washington, DC areas, to develop outreach programs to help their communities deal with disasters. The letter included a list of information and resources to help in case of a disaster. The information also is on the CMSA web site at www.cmsa.org.
When the first plane hit the World Trade Center, St. Vincents Hospital’s disaster plan went into effect. The nurses in Supportive Care went to the nursing command center, and the program’s non-nursing staff went into the general personnel pool.
"Within an hour or so after the disaster, we realized that our responses and our skills could be used other than in a medical manner," Hanley says.
Her staff worked at St. Vincents Family Crisis Center, initially helping families find out information about their loved ones who might have been injured, and later providing bereavement counseling in the hospital’s emergency room.
Within 10 days of the tragedy, Hanley realized that although most of the hospital could go back to its pre-crisis mode, in many ways her work was just beginning.
"The medical crisis was over very quickly," she says. "My understanding is that the vast majority of people were treated and released. It was very sad for the medical personnel on the front lines in the emergency room when they realized that the numbers we were prepared for were not coming in."
The supportive care staff was concerned about the effects that being a part of the crisis could have on the hospital employees. "We left the management of the Family Crisis Center to psychiatry and started focusing our efforts on employee support," Hanley says.
The staff circulated throughout the building in an informal way to see how the staff and patients were handling the crisis. Many patients witnessed the disaster from the hospital while waiting for surgery or treatment.
"It is important to let our employees know that everybody was affected by this tragedy," Hanley says. "They didn’t have to know someone who was hurt or is missing. They didn’t even have to be working that day. We also wanted them to know that even during the disaster, it was OK to do their normal job, whether it was performing surgery or answering the telephone."
Because the hospital was close to the disaster site, all hospital personnel were aware of the tragedy every time they left the hospital. With the help of human resources and other departments, the supportive care staff developed a curriculum on responses to stress and ways to combat it. Because of the size of the hospital and the number of staff, more than 40 sessions of the curriculum were presented.
"The other department heads and I felt strongly that this shouldn’t be a human resources presentation, but should be presented by people who are sensitive and have the ability to provide emotional support in case someone has a severe reaction or starts to break down," Hanley says.
Hanley anticipates having St. Vincents after-care model in place at least a year to help hospital staff and people in the surrounding community deal with the long-term effects of the tragedy. "The plan needs to take into account that people feel different reactions to different things, and that different things will trigger a reaction to the original disaster," she says.
For instance, the holidays, a birthday, or an anniversary may be particularly difficult for people. She anticipates that critical times for the community surrounding St. Vincents will be when the debris is finally cleared up and everyone is able to move back, when the companies that were located in the World Trade Center move into other offices, and next year’s Sept. 11 anniversary.
"We’re wisely taking proactive action. We are anticipating what this trauma may mean to the community around the hospital," she says.
Hanley suggests that other health care providers develop a steering committee to think about what will happen if there is a disaster in your community.
Think about what kinds of demands it will place on the services you provide, what needs there will be in the community, and what your organization can provide.
"Obviously, it will have to be adapted to the individual community, but it is very important that the institution really look on what they can do as an institution," she says.
Consider your community resources, what they are, and how they can help. "In New York City, there are a lot of resources and a lot of places where people can go for help. In a small community, this might not be true," she adds.
Don’t feel you have to react to everything. Instead, be proactive in your planning and decide what you can do in a cogent and thoughtful way, she adds. "If an organization decides it is going to focus on its employees and the immediate community, it needs to decide how it is going to react when someone comes in who is two streets outside the area it delineated," she adds.
The unimaginable has happened in New York City. At Saint Vincents Hospital, less than three miles from the site of the World Trade Center attack, the disaster plan was put to the test as dedicated professionals rose to the unique challenge of responding to the attack. American Health Consultants, publisher of Case Management Advisor, invites you to learn — from the firsthand experience of the professionals at Saint Vincents — how to take a new look at your disaster plans so that you will be ready if the unimaginable happens in your community:
Each participant will have the opportunity to earn 1.5 free AMA Category 1 CME credits or approximately 2 free nursing contact hours. For details, visit www.ahcpub.com, or call (800) 688-2421 to register today!