Readiness and response to public health emergencies: help needed now from professional nursing associations.

HETRAGEDYOFSEPTEMBER11,anthraxattacks,and severe acute respiratory syndrome (SARS) andother recent infectious disease outbreaks have heightenedour awareness of the need for health care system readinessand response capabilities. At the same time, the economicrealities of our modern health care system are reﬂected incost-containmentstrategiestowardlow-volumeinventories,reduced bed availability, downsizing of staff, and a shift tooutpatient services (American Hospital Association, 2002).Decreased reimbursement structures and workforce short-ageshavediminishedthehealthcaresystem’sabilitytomeetminimum patient demands, let alone the surge of patientsthatwouldbeexpectedinamass-casualtyincident.Further-more, the infrastructure needed for detection and responsefrom the public health sector has been seriously eroded bydecades of insufﬁcient funds. Agencies within the Depart-ment of Health and Human Services (HHS) have beenworking to address readiness and response capabilities, butprivateorganizationsandprofessionalassociationsalsohavea role to play.In keeping with the Public Health Security and Bioter-rorismPreparednessandResponseActof2002,HHSdevel-opedadepartment-widestrategicplantodelineateitsprior-ities. Within the plan, the Centers for Disease Control(http://www.bt.cdc.gov)andHealthResourcesandServicesAdministration(HRSA;http://www.hrsa.gov/bioterrorism.htm) have strategic activities in education, training, licen-sure, and credentialing for the public health care workforceand for hospital readiness. The Agency for Healthcare Re-search and Quality also has strategic activities related to ed-ucationandtraining,aswellasusesofinformationtechnol-ogy and electronic communication networks (Phillips,Burstin,Dillard,CPhillips,Dillard,&Burs-tin, 2002).HHS’s working deﬁnition of health surge capacity is theability a health care system has to rapidly expand beyondnormal services to meet the increased demand for medicalcareandpublichealthservicesthatwouldberequiredtocarefor patients in the event of a large-scale public health emer-gency or disaster. Needed resources include beds, personneltostaffthebeds,equipment,abilitytotransportvictimsandpersonnel, and the ability to provide ongoing care. All as-pects of surge capacity present challenges, but the demandfor qualiﬁed health care personnel is particularly complex.Although nursing is not the only health profession expe-riencing a workforce shortage, nursing is vital to any large-scale demand for care. Nationally, there are 2,694,540 li-censed registered nurses, or 808 registered nurses per100,000 people (HRSA, 2000). These numbers are insufﬁ-cient to meet current capacity needs and would be woefullyinadequateintheeventofamass-casualtyincident.Amass-casualty event would require mobilization of additionalnurses from outside the affected jurisdiction. Such a mobi-lization,however,wouldhavetoovercomeissuesofcreden-tialing and licensing. When licensed health care cliniciansarrivedasGoodSamaritansandvolunteeredafter9/11,hos-pital administrators turned them away because they did nothave the proper credentials.Nurses must collaborate and coordinate and train for fu-ture crises. Issues of competency, standards, and mecha-nismsforeducationandtrainingmustbeapprovedtocertifyqualiﬁed nurses for mass-casualty events. A major step wastaken in March 2001, when the International Nursing Co-alition for Mass Casualty Education (INCMCE) wasfoundedtoensureacompetentnurseworkforceinresponseto mass-casualty incidents. The INCMCE consists of orga-nizational representatives from schools of nursing, nursingaccreditingbodies,nursingspecialtyorganizations,andgov-ernmentalagencies.InJuly2003,INCMCEdevelopedasetof national, consensus-based, validated competencies for allentry-level nurses (INCMCE, 2003).Nursesmustalsoinitiatesystemsthatpromotetheirabil-ity to respond in the next crisis. In 1998, President Clintonsigned Presidential Decision Directive/NSC-63 (WhiteHouse, 1998), which established a national strategy for en-suring critical infrastructure protection, primarily cyberse-curity. In 2003, President Bush replaced PDD-63 withHomeland Security Presidential Directive 7 (White House,2003),whichidentiﬁedtherolesofthehealthcareandpub-lic health sectors. Speciﬁcally, it charged the sector-speciﬁcagencies to “collaborate with appropriate private sector en-tities and continue to encourage the development of infor-