Self-study: an effective method for bioterrorism training in the OR

AORN Journal, May, 2008 by Janet "Janie" Roberta Thomas

ABSTRACT

DURING A BIOTERRORIST ATTACK, health care professionals must be prepared to respond appropriately, but many perioperative nurses do not receive adequate education about bioterrorism.

ONE PERIOPERATIVE NURSE led a survey project to determine how prepared perioperative nurses were to respond during a bioterrorist attack and whether a self-study module would help increase participants' self-rated levels of preparedness.

THE RESULTS SHOWED that perioperative nurses generally felt unprepared to respond to a bioterrorist event. After reading the self-study module, nurses from facilities that both did and did not provide education on bioterrorism reported increases in self-rated levels of preparedness. AORN J 87 (May 2008) 915-924.

Americans are living in very uncertain times, with events of the past few years having forever changed the peaceful outlook for US cities. The United States is vulnerable to attack by both domestic and international terrorists, a fact that has become apparent as a result of events such as the bombing of the World Trade Center in New York City in 1993; the bombing of the Alfred P. Murrah Federal Building in Oklahoma City in 1995; and the airplanes flown into the Pentagon near Washington, DC, and the World Trade Center's Twin Towers in New York City in 2001, along with the tragic incidents involving 23 people infected by anthrax-laced mail in the fall of 2001. These events have created a feeling of uncertainty and a need to take extra precautions that were not considered necessary in the past.

Hospitals and other health care facilities are now faced with a new set of scenarios that require training for their staff members and the development of guidelines for reacting to emergency situations, including bioterrorist incidents. Although many hospitals have disaster management plans for dealing with the results of a natural disaster or terrorist attack, health care providers themselves may lack adequate training to respond appropriately in such situations. One perioperative nurse led an initiative to survey perioperative RNs at the 2005 AORN Congress in New Orleans, Louisiana, to determine how prepared these nurses were for handling the six "category A" biological agents or diseases as listed by the Centers for Disease Control and Prevention (CDC). The six category A agents, which are the ones most likely to be used in a bioterrorist event, are those that cause anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers. (1)

DISASTER PREPAREDNESS

The possibility of a terrorist attack employing the use of chemical or biological weapons of mass destruction on American soil has become very real. A weapon of mass destruction is defined as

   a weapon with the capacity to inflict
   death and destruction on such a
   massive scale and so indiscriminately
   that its very presence in the hands of
   a hostile power can be considered a
   grievous threat.
   (2)

The six category A agents listed by the CDC are all very contagious diseases, and a bioterrorist event involving any one of them could cause hundreds of thousands of sick people to descend on hospital systems for care. Even if individuals were lucky enough to be outside the primary event, they would be unlikely to escape the fallout from the primary event. All of the things such as food, water, utilities, and hospital supplies that people depend on daily are interconnected and interdependent. An interruption in one area of these services will quickly be felt in other areas and will affect everyone. In addition, in an age of frequent air travel, there is little hope that the rapid spread of a contagious disease can be contained by a simple quarantine.

In recent years, hospitals have worked vigorously to ensure that they will be ready to provide appropriate medical care to victims in the event of another terrorist attack. The Joint Commission modified its disaster preparedness standards in 2003 to include requirements for health care facilities to develop disaster plans that include identifying, preparing for, responding to, and recovering from potential disasters. (3) Unfortunately, that requirement has not solved all the problems, as evidenced by the aftermath of Hurricane Katrina in 2005, in which hospitals were left without electricity, water, medications, and other basic supplies for many days.

DISASTER AND TERRORISM PREPAREDNESS SURVEYS. Several surveys have been conducted in recent years to determine the level of disaster preparedness among hospitals. The results of these surveys indicate a need to implement additional disaster planning and education for health care professionals.

The US General Accounting Office conducted a national survey in 2003 to determine how prepared hospitals were for a disaster. The survey showed that the nation's hospitals at that time were not prepared to manage mass casualties resulting from chemical or biological weapons of mass destruction. (4) A study of hospitals in Mississippi published in 2006 found that, in general, hospitals were still not adequately prepared to care for victims of terrorist attacks involving chemical or biological agents that may result in the loss of hundreds or thousands of lives. (5) Even though 70% of the hospitals reported having provided some training to their personnel on identification and diagnosis of diseases caused by biological agents that would likely be used in a bioterrorist attack, fewer than 50% of the hospitals surveyed conducted drills to test their plan in the event of such an attack. Hospitals also reported that they lacked medical equipment necessary for a large surge in patient capacity. (5)