MASSACHUSETTS NURSE NEWSLETTER :: March 2005

MNA emergency preparedness task force accomplishments and future plans

By Chris Pontus

On September 11, 2001 and days following, the MNA received phone calls from nurses throughout the state of Massachusetts wanting to know what they could do to help. In response to our members' desire to assist during this tragic event the MNA established its emergency preparedness task force (EPTF).

Much has been learned through the formation and operation of the EPTF. During monthly meetings we heard many professionals and group representatives with the most current information regarding bioterrorism and emergency response efforts being made on federal and statewide levels.

Betty Sparks sits on the MNA Board of Directors and is also the chairperson for the emergency preparedness task force. Sparks works in the operating room at Newton- Wellesley Hospital with past experience in emergency room nursing. Sparks is also trained as a disaster medical assistance team (DMAT) member. DMATs are groups of medical and support personnel trained to provide emergency care during a disaster or other unusual event.

The following are highlighted activities, members, and support staff have been involved in through the EPTF:

In June 2003, MNA sent two staff members to the Department of Public Health (DPH) & Harvard School of Public Health for two days of training in facilitation, in Worcester on emergency preparedness.

Massachusetts satellite broadcast 1: emergency preparedness, incident command systems and connectivity

On July 8, 2003 representatives from the MNA participated in the emergency preparedness, incident command systems and connectivity program, produced by the Harvard Center for Public Health Preparedness in collaboration with the Massachusetts Department of Public Health. The broadcast was down-linked to 17 local community sites, with each site conducted and led by trained facilitators. Mary Sue Howlett and Chris Pontus participated as facilitators while Evie Bain represented MNA in attending a broadcast.

Satellite broadcast 2: isolation and quarantine

The isolation and quarantine program was one of a series sponsored by the Massachusetts Department of Public Health in collaboration with the Harvard Center for Public Health. A MNA representative has been a member of the planning committee for the broadcast series and assisted with facilitating in both programs. MNA sent three representatives to the March 30, 2004 session held at WGBH TV. The Isolation and Quarantine program was broadcast to multiple satellite sites. Betty Sparks, Marilyn Crawford and Gail Lenehan represented MNA.

Betty Sparks wrote an article and reported to the committee on her most recent DMAT training experience.

David Denenno and Betty Sparks wrote an article titled "Ten Things We Need to Know About SARS" for the Massachusetts Nurse.

State emergency preparedness

Barbara Toscano reported on the program "DPH Immunization Update 2004," which she attended.

• Dorothy McCabe attended and reported on the program "Legal Implications of Isolation and Quarantine."
• Chris Pontus reported on two programs she attended: "Annual Adult Immunization Conference on Influenza: Global Awareness, Local Preparedness" and "Bio-terrorism and Animals."
• Mental health and emergency preparedness. The need for those caring for mental health patients to be educated in "How to care for them in event of emergency in group homes" was raised by Rosemary O'Brien.
• CDC certification training to administer the smallpox vaccine through the MDPH was attended by Evie Bain & Chris Pontus.
• Smallpox information and update was offered through MNA and presented to MNA members by Evie Bain.
• A community hospital's emergency management plan was brought in by Marilyn Crawford and reviewed by the group. This review served as a learning tool to measure and identify the strengths and weakness of an existing plan.
• Follow-up to a community hospital's response to chemical exposure. Jean Crawford described the event and lack of appropriate response by medical personnel. The need for education regarding interpretation of material safety data sheets (MSDS) as well as utilization of poison control as an immediate resource was identified in this specific situation and globally.
• Policies & procedures relating to emergency preparedness – The first draft of a policy to address actual or suspected exposures was developed and reviewed by Liz O'Connor and Janice Homer. Questions for bargaining units to ask prior to emergency preparedness training were brought to be field tested through a questionnaire with their labor management groups.

Continuing education programs

• Bombs, clean and dirty. Jonathan L. Burstein, MD, FACEP from the Massachusetts Department of Public Health, presented at the MNA an in-depth program on: "Bombs and other explosive devices, their mechanisms, effects, and preparation for and response to the emergencies created by the use of these devices" on June 22, 2004. This program was well-attended, enthusiastically received and generated a lively question and answer session.
• Incident command system for health care providers. This continuing education program was sponsored and provided by the Massachusetts Executive Office of Public Safety and the Massachusetts Department of Fire Services held at MNA on June 2, 2004. Members who attended shared their experiences, emphasizing the great value of the participants' application of learning to specific potential emergencies.
• Emergency medical response to hazardous materials and acts of terrorism. The Massachusetts Emergency Management Agency (MEMA) sponsors this program on emergency medical services in response to hazardous materials and acts of terrorism. The program is offered at the MNA on a consistent basis in the fall and spring. It is designed for physicians, nurses, EMTs and hospital support staff. The program includes identification of hazardous materials, toxicological and biological effects of chemicals and biological acts of terrorism.

Anthony Fucaloro, EMT and Captain Larry Ferazani outlined training initiatives and efforts being made through Massachusetts Emergency Management Association (MEMA). A predominate theme was the concern that Massachusetts' hospitals are not prepared to accept large numbers at this time. Also, initial assessment and decontamination efforts need to take place prior to individuals taken to a hospital environment. Planning for major catastrophic events at this level yet need to be developed.

Mary Taschner, DPH liaison to the Massachusetts Department of Fire Services, described the activity of "defined area work group" which is developing a standardized curriculum for emergency preparedness. The national model is being adapted to state-level needs. Preliminary standards have been developed for health care, public safety and public health workers.

Erica Fasano from Boston EMS presented information on the Boston Medical Reserve Corps. She spoke about her role and what her agency is doing in trying to organize nurse volunteers. This is one of seven federally funded medical reserve corps in Massachusetts. The corps provides a health care team which responds to disasters. Informational literature was distributed. Application forms were available for those wishing to become members.

Amy Zepecki, from Boston EMS presented an overview of the city of Boston's involvement in and with the national stock pile. Lisa Gurland, MDPH director of clinical affairs & personnel development presented a federal and state plan as it relates to a behavioral health crisis response for the general population in a disaster. The specifics of this plan addressed mental health needs of the general population in a disaster.

Robert Paone, B.S., Pharm.D, statewide national stockpile coordinator for the Massachusetts Department of Public Health, presented "Disaster Preparedness: National, State and Local Response." The focus addressed the deployment and utilization of the national stockpile of emergency equipment, medications and supplies in a disaster. Dr. Paone has developed a plan for DPH's response to an emergency declared by the governor.

Glynnis LaRosa, RN, MPH, senior public health nursing advisor, DPH, presented a report on the DPH infectious disease response & emergency plan. LaRosa reviewed smallpox pre and post-event planning still underway by DPH and handed out materials related to this training. DPH is seeking nurses to be trained in smallpox vaccine administration. The Massachusetts Dispensing and Vaccine Site Planning template is on the DPH BT (Bioterrorism) Web site. Glynnis noted that drills and exercises are being conducted by towns and that 12 Massachusetts sites were funded in the past year for the Medical Reserve.

Maxene Armour, education coordinator, coordinator, from the Department of Argricultural Resources, Division of Animal Health, Biosecurity and Dairy Services presented a program called Bioterrorism and Animals: Awareness and Response. Armour presented literature and information on the relationship of animal diseases to human diseases (Zoonosis). As animals can be reservoirs for human pathogens, a bioterrorism event may also affect animal health (Sentinels) and those working with animals need be aware of that potential.

Beverly Anderson, MPH, CHO regional preparedness coordinator. A proposal for MNA volunteers to be contacted for assistance in a bioterrorism event is being considered by the Emergency Preparedness Task Force. The task force was positive and thought this was an area for MNA participation.

A request was made for Anderson to present a written proposal addressing the committee's concerns for submission to the MNA Board of Directors for consideration. Items of confidentiality of information, protection from lawsuits, conflict of responsibilities to those in other responder groups, training, were discussed.

Going forward

MNA Board member Sandy Eaton and MNA staffer Joe-Ann Fergus encouraged the diversity and emergency preparedness committees to investigate concerns raised by the Roxbury and Boston Medical Center communities about Boston University's plans to build a level 4 bio-terrorism lab in Roxbury. An informational forum was conducted on Dec. 15 at MNA headquarters.

Both BU spokespersons for the laboratory and members of the scientific community opposed to the laboratory presented information with discussion of their positions on the location of the BU level 4 laboratory. Representatives of Alternatives for Community and Environment (ACE), the opposing group, gave a presentation, followed by one from representatives from Boston University Medical Center.

Sandy Eaton developed an MNA position statement concerning the BU facility with input from other members of the committee including Mary Crotty, who tracked new legislation to require state regulation of the laboratory sponsored by state Reps. Gloria Fox and Byron Rushing. The Fox-Rushing bill, "An act to protect the public health and environment from select toxic biological agents," was finalized following the highly publicized disclosure on Jan. 20, 2005 that BU had experienced an outbreak of tularemia in one of its current research laboratories in the past year, but had failed to disclose the potential disaster, as was required legally, to regulatory agencies and public health authorities. A position statement opposing the development of the level 4 laboratory was accepted by MNA board members for approval. At this point, the task force will continue to monitor the situation.

The task force briefly discussed the need to address/explore potential MNA's role in a disaster. In going forward the task force will look toward the possibility of developing a partnership with the Department of Public Health. The task force hopes to define roles that are within member regions. Some of the issues for review include recommendations relating to current license, scope of practice, training, liability and insurance needs. Discussion will continue at future meetings. The task force will subsequently put forward recommendations to the MNA Board of Directors.

The task force does have some noted concerns with language barrier in the event of a bio-terrorism event.