Smallpox is a prime example. The federal government has designed grants to help hospitals and public health departments prepare for smallpox; however, funding does not cover the operational expenses required to implement the national guidelines. Costs will vary from county to county, depending on how prepared counties and facilities are. As a result, health care organizations, in many instances, have to curtail or eliminate other emergency preparedness programs and divert resources to meet shortfalls.

What this means is that while we are busy preparing for smallpox, we could be blindsided by a completely different catastrophe. For example, are we prepared to handle a week-long heat wave of 98° with 95% humidity during a power outage on the Eastern seaboard? Can we care for more than 1.2 million acute respiratory distress cases in 24 hours during a severe regional smog event? Can nurses respond adequately to being quarantined for 10 days as part of a public health measure?

The bottom line is that the issue isn’t smallpox or SARS or even bioterrorism: the issue is emergency preparedness. Nurses, along with the patients for whom they care, are in jeopardy if this distinction is not clearly understood. Health care professionals must meet a level of preparedness borne out of a unified communication system, administrative and engineering controls, training, and proper personal protective equipment. The response must be a well-designed and practiced plan. Unfortunately, nationwide, very few health care facilities, public health departments, or businesses meet this level of preparedness.

As nurses, we are on the front lines of care and have a unique perspective to offer on emergency preparedness. It requires an analysis of the facility, both internal and external, for all hazards and threats; emergency preparedness plans must be designed generically but applied specifically.

This can be accomplished by creating an emergency preparedness committee consisting of representatives from all areas within the facility. The use of a matrix that addresses four areas—planning, mitigation, response, and recovery—will help identify commonalities that can be incorporated into an integrated plan.

Planning. This ongoing process prepares health care workers for problems involving hazard management and resolution. Planning considers facility integrity, policies and procedures, staffing, integration with other agencies, and resource allocation.

Response. This phase should be developed as close to the common facility routines as possible. A crisis adds chaos to a nurse’s routine, but does not change a nurse’s responsibilities. A well-designed response plan takes advantage of a nurse’s skills, while decreasing the elements that contribute to chaos. One way to decrease the chaotic elements of a crisis is to work with­in the structure of a hospital emergency incident command system (HEICS), which uses clearly de­fined roles and responsibilities, as well as a common nomenclature, to assist in coordinating hospital emergency activities with other emergency responders. The HEICS is a mandatory requirement of the Joint Commission on Accredita­tion of Healthcare Organizations’ and the Occupa­tional Safety and Health Admini­stration’s emergency response plans.

Recovery. The goal here is getting all routines back to normal, including the building and material aspects as well as all personnel activities. The recovery processes have to be defined before an emergency occurs, to facilitate a seamless transition to the facility’s preemergency status.

Emergency preparedness is a dynamic process integrating the skills and responsibilities of nurses, management, union leaders, employee representatives, subject experts, and community agencies. If we are to be truly ready for the next infectious disease outbreak, bioterrorism threat, or natural or manmade disaster, we must have an effective and comprehensive emergency preparedness plan in place at every facility and in every community across the nation.

Thomas J. Lowe is an occupational health and safety representative at the New York State Nurses Association and past president of the Hudson Valley New York Association of Occupational Health Nurses, Inc.

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