ight hundred New York City public school nurses who took an emergency training program that ended Aug. 31, 2001, never expected they would so quickly put their course work to use.
But on and after Sept. 11, some of these public health nurses who are assigned to the schools helped set up the school-based Red Crossshelters in the city and worked hotlines providing information to the public. A little later, the nurses were collecting nasal swabs from postal workers during the anthrax spore mailings.
The nurse preparedness training was a collaborative program sponsored by the Centers for Disease Control and Prevention and developed by Columbia's School of Nursing and Mailman School of Public Health and the New York City Department of Health. Now, Columbia researchers are beginning to evaluate how the training helped in the nurses' response and how to improve the curriculum.
What is learned could help in future preparedness training of nurses and other health care professionals. Although nurses and health care professionals are typically equipped to deal with clinical emergencies in patients for whom they have regular responsibilities, many need additional instruction in responding to catastrophic events, such as bombings, bioterrorism, and earthquakes.
"The seminars were designed to make sure the response to emergencies is faster and smoother and that we have better resources for bigger emergencies," says Dr. Kristine Gebbie, associate professor of nursing and director of the Center of Health Policy at the nursing school. Dr. Gebbie helped train the nurses pre-Sept. 11 and worked as a nurse coordinator for all the nurses in the Red Cross shelters set up after the World Trade Center towers collapsed.
The instruction concentrated on teaching the public health nurses in the schools how they fit into an emergency response system--such as working in shelters, responding to medical needs of victims, and communicating with the public. They also learned about the chain of command when working with emergency personnel from city, state, federal, and other agencies. "A lot of the training has to do with knowing where to go and having a plan ready to use," Dr. Gebbie says.
Dr. Gebbie describes these "core competencies" in response to an emergency in an article she co-authored in the January issue of the American Journal of Nursing. "What needs to be done is to strengthen the emergency planning function in every health and illness care setting, to include emergency preparedness in every health science curriculum and in all new employee orientations, and to allow time and funding for regular drills and practice," Dr. Gebbie says.
Preparedness training continues to evolve and Health Sciences researchers are heavily involved in shaping the field: Dr. Stephen Morse, director of the public health school's Center for Public Health Preparedness, and Jacqueline Merrill, a project coordinator at the center, are leading the nurse training evaluation. Dr. Gebbie and fellow investigators at the center--Dr. Robyn Gershon, assistant professor of clinical public health; Dr. Marita Murrman, assistant clinical professor; and Dr. Wafaa El-Sadr, professor of epidemiology--also will participate in the appraisal. This team will interview the nurses and conduct focus groups to aid in the program assessment. Ultimately, the city health department plans to train all its workers and will offer additional instruction for the school-based nurses.
Initial data from tests the nurses took before and after the training showed positive results. "Participants did learn the material presented and it broadened their understanding of public health emergency response," Dr. Gebbie says.
Besides evaluating the training for the nurses, the entire city Department of Health response to the Sept. 11 events will be examined through a joint effort of the department and Columbia's Center for Public Health Preparedness. Investigators will conduct interviews and focus groups of staff members involved and assess the data the health department collects, such as records of diseases and environmental monitoring.
This larger evaluation is being done at the request of the Department of Health, which will receive the results. Eventually, those involved hope to publish a collaborative assessment of the lessons learned.