PH GUEST EDITORIAL
Disaster Preparedness—
R i ch a r d R i c c i a r d i , M S , R N , C P N P / F N P
T his issue of the Journal is dedi-
cated to the women, men, and children
who, during times of a natural or hu-
manmade disaster, responded by giv-
ing selflessly of themselves for the ben-
efit of us all. It is with heavy hearts that
we remember and honor those who
made the ultimate sacrifice as a result
of or in the aftermath of the devastating
acts of terrorism that occurred 1 year
ago.
The world will never be the same
again. How many times have we spo-
ken those words since September 11,
2001? I grew up in New York City and
felt shock, anger, worry, uncertainty,
and helplessness in the wake of the at-
tacks. I was at home, less then 10 miles
from the Pentagon, when the attack oc-
curred, and I remember wondering
what I could do to help those in need.
Should I get on my bicycle and ride
there and begin to triage and provide
emergency care?
We have had 1 year to reflect on the
events of September 2001. During this
time, we have been saturated with im-
ages, commentary, and articles depict-
ing the evils of terrorism. The threat of
biologic, radiologic, and chemical agents
has become a reality. As the reality and
ongoing threat of terrorism became a
part of our daily lives, we asked our-
selves how this would affect our fami-
lies, our nurse practitioner practice, our
health care systems, our communities,
and our souls.
Remarkably and instinctively, we
have come together to fight terrorism as
a unified group of Americans. As my fa-
September/October 2002
The Courage
to Respond
ther would say, we “buckled down”
and rose to meet the enemy head on.
We realize that indeed the world will
never be the same after September 11,
2001. However, we are not the first to
experience such a realization. These
H
istory reminds us
that we are not the first
generation to deal with
disaster, and that healing
and enlightenment
are possible.
same words have been spoken in refer-
ence to other periods of our history. I
envision citizens of this great country
discussing how the world will never be
the same during and after the American
Revolution, Civil War, the stock market
Richard Ricciardi is Adjunct Assistant Professor, Uniformed Services University of the Health Sciences,
Bethesda, Md. He is also the Treasurer of NAPNAP.
Reprint requests: Richard Ricciardi, MS, RN, CPNP/FNP, 6815 Meteor Place Apt. 302, Springfield, VA 22150;
e-mail: Richard.Ricciardi@NA.AMEDD.ARMY.MIL.
J Pediatr Health Care. (2002). 16, 211-212.
Copyright © 2002 by the National Association of Pediatric Nurse Practitioners.
0891-5245/2002/$35.00 + 0 25/8/127484
doi:10.1067/mph.2002.127484
crash, World War I and II, and the Holo-
caust. History reminds us that we are
not the first generation to deal with dis-
aster, and that healing and enlighten-
ment are possible.
A disaster can be defined as a natural
process or an event caused by humans
that deprives people of life, health, liveli-
hood, or property and with which the af-
fected country cannot cope (United
States Agency for International Devel-
opment, 2002). As primary care provid-
ers, pediatric nurse practitioners will be
called upon not only to be first respon-
ders in times of a community disaster
but to ensure that the health care needs
of children are addressed in local and na-
tional disaster response plans as well.
Designing a community and national
disaster response plan will require mul-
tidisciplinary collaboration at the high-
est and, perhaps, unprecedented levels,
including forming partnerships with ex-
perts in public health, infectious disease,
the military, academic centers, and non-
governmental agencies. This is a formi-
dable challenge considering the limited
amount of information currently taught
on disaster management and treatment
of biologic, radiologic, or chemical in-
juries in most advanced practice nursing
211
PH GUEST EDITORIAL
C
curricula, and until recently, limited con-
tinuing education offerings.
In developing a disaster response
plan, much of what we can learn from
and build on comes from governmental
agencies such as the Department of
Health and Human Services, the Fed-
eral Emergency Management Agency,
and The Department of Defense, and
from nongovernmental agencies such
as the American Red Cross. As federal
agencies reorganize and lines of author-
ity are adjusted in the newly formed De-
partment of Homeland Security, it is
clear that nurses across all specialties
will play a significant role in the overall
medical disaster response strategy. The
current Federal Response Plan has 12
emergency support functions, two of
which involve the medical response. Af-
ter acquiring additional education and
hands-on training in the care of biologic,
chemical, and radiologic casualties, it is
my belief that advanced practice nurses
will be well suited to be part of disaster
medical assistance teams at the local,
state, and federal level. The attacks of
September 2001 quickly awakened the
need to restructure our approach in re-
sponding to national disasters. Ongoing
research on the many components of a
medical response to a disaster is critical.
One possible approach is to begin by as-
sessing current strengths and identify-
ing gaps in practice, education, re-
search, and health policy, focusing
primarily on three areas: patient/indi-
vidual, health care provider, and the
health care system.
Disaster preparedness begins with
education of the patient. Since Septem-
ber 2001, we seem to be facing a surge of
questions from patients that are difficult
to answer. One example is concerns re-
garding the use of vaccinations. When
vaccines for smallpox, anthrax, or other
biologic agents become available, who
should receive them? Difficult ques-
tions arise regarding vaccination of bio-
212 Volume 16 Number 5
logic agents in children, either as a pro-
phylactic measure or as treatment dur-
ing a suspected or confirmed exposure.
Another critical area is the psychologi-
cal effect of disasters and terrorism on
the patient, family, and community.
Two articles presented in this issue of
the Journal specifically focus on the key
psychological components regarding
children and their response to disasters.
D esigning a
community and national
disaster response plan will
require multidisciplinary
collaboration at the
highest and, perhaps,
unprecedented levels
NAPNAP is currently partnering with
the American Academy of Pediatrics to
take an active role in incorporating the
unique needs of children in the Federal
Response Plan. In the current disaster
response plan, specialty disaster med-
ical assistance teams have been desig-
nated to care for trauma, burn, and pe-
diatric patients.
A second area to focus on is the safety
and educational needs of health care
providers. During a disaster, safety of
all personnel is at the forefront. The dis-
aster response plan should include
terms to provide the most up-to-date
technology and tools to ensure the
safety of all heath care workers. Com-
Ricciardi
munication at both the local and na-
tional level is critical. I believe, in the
event of bioterrorism, the Centers for
Disease Control and Prevention will be-
come the best source of information on
treatment and threat risk. The ongoing
educational needs of the nurse practi-
tioner may be most efficiently met by
utilizing distance education technolo-
gies and courses on the Web. Many uni-
versities have begun to integrate con-
tent into the curriculum regarding
identification and treatment of biologic,
radiologic, and chemical agents.
The third area to review is the health
care system’s ability to successfully re-
spond to a disaster. Organizations like
the Armed Forces, Public Health Ser-
vice, and the American Red Cross have
a long history of providing health care
in austere and disaster settings, and
they provide a wealth of information
from nurses with firsthand experience
regarding agent identification, evacua-
tion, decontamination, personal safety,
command and control, equipment
needs, and training. Testing the pre-
paredness of the health care system and
providing continuing education to
health care providers will be expensive,
and questions regarding how costs will
be distributed will need to be answered.
Someone once told me that courage
is defined by the ability to move for-
ward not knowing the outcome. The
truth is that no one can predict the loca-
tion, timing, or nature of the next disas-
ter, just that another disaster is in-
evitable—so we must be prepared!! If
you have any comments, please write
to me at the following e-mail address:
Richard.Ricciardi@NA.AMEDD.ARMY.
MIL.
REFERENCE
United States Agency for International Development.
(2002). Automated Directives System, Series 200,
Chapter 251. Retrieved from http://www.usaid.
gov/pubs/ads/glossary.doc
JOURNAL OF PEDIATRIC HEALTH CARE