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New Program Prepares US Nurses for Terrorist Attack

Since the terror attacks of September 11, 2001, many U.S. communities and hospitals have had to admit they might not be ready for a chemical or bio-terrorist attack. With that in mind, a team of medical professionals from St. Louis University's School of Public Health recently traveled to Israel to see the methods that country's health care system has developed in response to years of terrorism.

Sitting in his office at St. Louis University's School of Public Health, Greg Evans is uneasy. "I think we're very vulnerable right now as a nation, " he said.

As Director of the School's Center for the Study of Bioterrorism and Emerging Infections, Mr. Evans is responsible for addressing that. His is one of just seven Specialty Preparedness Centers in the United States funded by the Centers for Disease Control and the only one dealing directly with bio-terrorism and the development of educational material for the public health community. Over the past year, many towns and cities have taken steps to prepare for potential future attacks. But Mr. Evans questions U.S. hospitals' ability to respond. "I do believe they'd better deal with it somewhat better today than they would have been a year ago," said Greg Evans. "But they're nowhere near being prepared and therefore what is done over the next year will really determine how many individual lives can be saved."

Much of the knowledge and expertise to respond to a terror attack already exists in the United States, it's just a matter of learning how to "connect the dots." Terri Rebman, an infectious disease specialist at the Center, says it's especially important to connect nurses to the system. "I do a lot of disaster preparedness training, and nurses seem to be the one group that has been left out more than the other groups," she said. "And they're such a large piece in disaster preparedness and they were really lacking a lot of the training. Most of the training seems to be focused on first responders."

Center director Greg Evans says he wants to develop a post-baccalaureate curriculum that will turn out leaders who can prepare hospitals, while at the same time training front line nurses who can respond to a variety of attacks. "Every hospital in the country right now is looking for this type of leadership," he said.

So he, other Center leaders and faculty from the St. Louis University School of Nursing headed to Israel and the Hadassah Medical Organization in Jerusalem, the largest medical treatment facility in the Middle East.

The five-member team videotaped all of their tours and discussions. At the hospital, the group worked in protective suits.

They visited a gas-mask distribution center, and learned about triaging, decontaminating and transporting large numbers of patients. They toured an area outside the hospital that can quickly be set up with 50 showers to decontaminate many people at a time.

Assistant professor of nursing Joanne Langan says that an effective response plan must involve every medical professional, every nurse throughout the system, from the emergency room to geriatrics. "I don't know if they'd have the first clue about how to triage patients and the decontamination is something most nurses wouldn't know about," said Ms. Langan. "It's something we have to teach and practice so it becomes second nature just as CPR becomes second nature with us after the training. You just go into that automatic mode."

Back in St. Louis the team is literally triaging the lessons they learned to create a comprehensive plan as quickly as possible. The curriculum will center around three areas: creating a medical response plan, personal protection and psychiatric preparedness.

Usually, when an institution like a nursing school develops a new curriculum, the process takes a few years. This small task force recognizes they don't have that kind of time. Assistant professor of nursing Dotti James is on the team. "This is not something to take three years to look at and evaluate and send surveys out," she said. "This is something nurses are ready to learn right now. Our role is to coordinate what we have."

The course will be made available through distance learning. The lessons will be distributed on CD. Questions and exams will be handled over the Internet. The program should be online in January.