This study examines the preparedness and ability of Emergency Room Physicians (ERPs) to respond to chemical, biological, radiological, nuclear and explosive (CBRNE) incidents. In an age of terrorism, these agents are designed to promote fear and if released cause injury or kill American citizens. ERPs are front-line first responders responsible for any person who walks into their emergency room. Yet, the area of preparedness and operational capabilities with these providers of care remains unknown. This study provides results from generic qualitative interviews of ERPs. One of the primary purposes is to assess the importance of education and training and allow ERPs the opportunity to provide their perspective on coordination of response from the lowest level of government to the highest level of federal government by use of the National Incident Management System (NIMS). Other purposes included assessment of their involvement in community preparedness and the ability to properly utilize PPE when needed. Increases in the frequency of these types of events threaten every city in the United States. History is replete with past examples of these types of incidents in the United States and throughout the world. These ERPs and others serve communities throughout the country and provide significant medical care for those in the community where they live and work. In this study, they provide input on the consequences of unpreparedness during CBRNE incidents, either by intentional or unintentional release. ERPs agreed that medical professionals must have an ability to adapt to and control these critical situations to care for patients and protect resources. This evaluation of their perspectives is based on five preapproved themes and three emergent themes, and provides recommendations and suggestions for follow-up of future studies in this area of preparedness.
This paper is dedicated to those I love, my husband, my daughter, my son and stepson. It is my sincere wish that this work be an inspiration to all my grandchildren in pursuit of their life-long goals and my personal aspiration for them in the completion of their educational requirements. To my mother who always expressed the importance of education in preparing each generation for a more prosperous life of fulfillment.
This has truly been a very long journey, however Dr. Kathleen McKoy, my mentor never gave up on me and continued to encourage me to the end. I wish to personally convey my sincere appreciation and gratitude. I would never have completed this work without her determination to see me succeed. Thank-You!
PERCEPTIONS OF EMERGENCY ROOM PHYSICIANS IN MANAGING CHEMICAL, BIOLOGICAL, RADIOLOGICAL, NUCLEAR AND EXPLOSIVE INCIDENTS
CHAPTER 1: INTRODUCTION
1.1 The Study
Historically, research has shown medical professionals are less prepared to handle large-scale medical emergencies such as terrorist attacks without adversely affecting themselves. They generally are not properly prepared to cope with, respond to and mitigate incidents involving chemical, biological, radiological, nuclear and explosive (CBRNE) incidents. Emergency Room Physicians (ERPs) are a critical component of the initial response team in any size city. It has been consistently reported that these types of incidents have the capacity to overwhelm local and state resources (human and non-human), which can lead to injury and death of citizens (Ekker, 2016). However, according to most medical and emergency planner experts they may not be involved in the preparedness and planning for these types of incidents. Stevens, Jones and Smith, Nelson, Aghos (2010) study confirmed results that supported others findings that CBRNE training and preparation is associated with higher preparedness and a willingness to respond to these types of critical incidents.
As noted in the introduction of this study several authors have concluded that medical professionals may not be prepared to handle major disasters in this country. It was also noted that the potential for CBRNE incidents (man-made/deliberate and accidental) are becoming more prevalent in this country. In the state of Louisiana alone, there are more than 200 chemical plants and this state has the 2nd largest number of chemical plants in the United States. There are also 3 nuclear plants in south Louisiana which could potentially impact the residents in the state, as is a military base in northern Louisiana where nuclear weapons are stored (Buchanan, 2013; State of Louisiana EOP, 2014). Therefore, a need for ERPs who are members of the 1st responder team to be prepared to care for patients, protect staff and resources which may be adversely affected by CBRNE disasters (Ziskin & Harris, 2007).
Yet, medical professionals may not be prepared to handle these types of disasters, therefore, it is critical to determine the preparedness of medical staff for CBRNE incidents. The consensus among medical professionals and disaster managers is that citizens may suffer in the event of unpreparedness of medical staff to handle CBRNE and other major disasters (McCann, 2009). Recent incidents and prolific occurrences of accidental and deliberate hazards provide evidence that disasters can and will cause devastating consequences to the citizens of the state of Louisiana. They may cause negative consequences here and in other locations of the US.
Stevens, Jones and Smith, et.al, (2010) expressed that the primary result of CBRNE incidents or terrorist attacks is fear and medical professionals must have an ability to adapt to and control this emotion. These authors concluded that concern for family did not affect these professionals ability to respond to CBRNE incidents. However, experience was deemed just as important as training, therefore education and training will be studied to determin...
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