Exploring Medical and Public Health Preparedness for a Nuclear Incident Proceedings of a Workshop (2019) / Chapter Skim
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6 Challenges for Building Capacity Within the Health Care System
6 Challenges for Building Capacity Within the Health Care System
Pages 93-110
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From page 93... ...
includes more than 80 cancer centers, blood donor centers, and cord blood banks nationwide preparing to care for patients with acute radiation syndrome (ARS) ; it is included in several fed eral disaster response plans.
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From page 94... ...
(Norton) In the final session of the first workshop day, moderated by Bruce Evans, fire chief, Upper Pine River Fire Protection District, Colorado, panelsts with i varied health care systems perspectives continued the exploration of commu nication, education, and information challenges posed by a nuclear incident; the implications of these challenges for capacity building; and opportunities and approaches for addressing them.
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From page 95... ...
The intensive and variable nature of burn care creates a challenge when considering the massive amount of injuries and different types of patients that would result from a nuclear incident. Geographic Distribution of Burn Care Across the United States Adding to the challenge is the limited geographical distribution of burn centers across the United States (see Figure 6-1)
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From page 96... ...
With respect to comprehensive pediatric burn care and where most U.S. pediatric burn nurses are located, there are four freestanding pediatric burn hospitals and five burn units in freestanding children's hospitals.
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From page 97... ...
Regarding previous workshop participants' descriptions of burn care as the Achilles' heel, or rate-limiting step, of medical care in the event of a nuclear incident, Bettencourt agreed: "If you do not have a nurse to care for these patients, a lot of the care is going to get delayed and not happen." Burn Nurse Competencies A recent ABA task force identified nine burn nurse competencies ( arrougher et al., 2017)
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From page 98... ...
or dressing changes needed. When planning for a nuclear incident, she encouraged considering this type of strategy -- tasks that can be done by other nurses as well, not necessarily burn nurses, and that conserve resources.
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From page 99... ...
Finally, Bettencourt suggested thinking about opportunities where burn nurses could serve as consultants to the rest of the nursing community if one of these events were to occur. Perspective of the American Burn Association: More on Burn Care as the Achilles' Heel of a National Response to Thermonuclear Detonation Jeng continued the discussion on burn care as the Achilles' heel of a na tional response to a thermonuclear detonation and described some actions that ABA has taken recently that are relevant to a national response effort.
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From page 100... ...
Then, from that platform, they will publish a practice guideline for combined care for radiation and thermal burns. He called for trauma units in particular to break down their silos, as trauma professionals are really the "band leaders" for any big mass casualty event in the United States.
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From page 101... ...
Jeng em phasized that the only way there is going to be any cogent response to 20,000 or 200,000 burn casualties is to pour "big money" into basic science and translational science research about how to stop partial thickness burns from progressing to full thickness burns. In other words, the "magic bullet," he said, is how to keep second degree burns from evolving, as they do, into third-degree burns.
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From page 102... ...
Diagnostic Laboratory Challenges After a Nuclear Incident Although the topic of burn care would reemerge as a topic of primary concern in the open discussion with the audience at the end of this panel, in the meantime, the focus of the discussion shifted to other key challenges to building capacity within the health care system. The first of these is diag nostic laboratory capacity.
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From page 103... ...
Following a nuclear incident, the initial priority would be to quickly determine who needs medical management and radioprotective medical countermeasures, which are available either in the Strategic National Stock pile or locally. Thus, Jones said, the preferred method of testing during the first 7–10 days would be biodosimetry.
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From page 104... ...
In a nuclear detonation scenario -- a resource-scarce environ ment with limited medical countermeasures -- the response community will need to be able to identify who really needs these countermeasures and who does not. Radiation Injury Treatment Network Case provided an overview of RITN and its potential role in a nuclear incident and discussed what he perceived as some of the most important
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From page 105... ...
or hematol ogy units that are working together to prepare for mass casualty incidents with radiological injuries that affect the marrow. Each year, RITN members are required to carry out a number of training and exercise tasks and to maintain institutional review board (IRB)
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From page 106... ...
There are many people who assume that a nuclear incident is not something that will hap pen to them. Even in 2017, with the threat from North Korea, although there had been more interest, in Case's opinion, still there had been a lot of people who had believed that the media was making a "big hubbub" out of nothing.
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From page 107... ...
Getting people's attention is a "neverending cycle," he said. Role of Medical and Clinical Toxicologists in a Catastrophic Nuclear Emergency Kazzi underscored the medical care challenges of a nuclear incident stemming from a very large number of victims combined with an inade quate number of health care providers and medical volunteers.
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From page 108... ...
He sug gested perhaps considering centers of excellence of care given that certain types of incidents, like mass burn events or an outbreak of a highly lethal disease like Ebola, have the capacity to overtax the resources of a single country. Discussing burn events, Norton echoed Jeng's comments earlier in the session.
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From page 109... ...
However, there is an opportunity with advanced practice nurses1 -- having more of them might be a way to expand burn professionals. Colleen Ryan of Harvard Medical College added that the shortage in burn expertise extends to other health care professionals as well, including therapists, pharmacists, etc.
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From page 110... ...
To overcome this problem, it was decided that individuals would be preferentially selected from those positions to serve in overseas disaster response. The word spread quickly.
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