orm_february-2024 - 26

STAFFING
BY DAVID WALSH
Disaster-zone deployments demand courage amid crisis
N
ursing is not a career path for
the faint of heart. However,
working in places wracked by
civil strife and natural catastrophes can
strain the composure of the most elite
in any specialty. If the OR tent lifting
away in strong post-hurricane winds
stateside is not bad enough, imagine
having armed soldiers or insurgents demand
anesthetized civilians be dumped
and replaced with their wounded. The
same goes for random harassment and
supply convoy diversions (ie, pillaging).
Even absent these extreme (but documented)
examples, nurses deployed
overseas are likely to contend with
dodgy internet, language barriers, logistical
problems, and other factors that
demand not just the right core qualifications
and competencies, but also
special training and significant fortitude.
" Responding to a
major disaster, mass
shooting, bombing, or
terrorist attack is not for
everyone, " says Kathy
Van Dusen, MSN, RN,
CEN, CPEN, NHDP-BC,
FAEN, a veteran of multiple
disaster- and crisis-zone
deployments.
" Nurses need to be prepared
to face extreme
Kathy Van
Dusen, MSN,
RN, CEN,
CPEN, NHDPBC,
FAEN
injuries, potential violence, and austere
working conditions. "
Van Dusen was one of two nurses
with foreign posting experience interviewed
by OR Manager last fall. Other
sources for this article include the head
nurse of a prominent international aid
organization and a spokesman for the
Defense Health Agency (DHA, which is
tasked with various aspects of managing
the Military Health System).
The courageous get creative
Van Dusen's first advice for any nurse
thinking of volunteering for a crisis or
disaster zone is to avoid going solo. For
one, organizations such as Nurses Without
Borders and the Emergency Nurses
26
OR Manager | February 2024
Association (ENA) perform the critical
task of vetting potential care providers
to verify their licenses, certifications,
and other qualifications. For another,
humanitarian and other organizations
provide backing in the form of not just
other healthcare professionals, but also
communications specialists, logistics
personnel, and safety experts. They
also can offer relatively resilient supply
chains, help cultivate local relationships,
and provide safe places to live
and work, which can range from large
tents to office buildings, gymnasiums,
and churches.
Consider the experience
of Melanie Perry,
BSN, RN, CNOR, CSSM,
founder and chief nursing
officer of First Case
Media. Perry spent an
intensive week in Honduras
with the nonprofit
organization One World
Surgery. Her team comprised
two surgeons and
cal supplies often scarce or not readily
available, but they may be labeled in a
language the nurse is unfamiliar with. "
In the face of such difficulties, quickthinking
staff must often rely on unorthodox
solutions. " While some facilities
and countries will not have everything
that we think we need to function, it's
amazing what can be accomplished
when people are dedicated to the perioperative
profession and to providing
surgical care, " Perry says.
Melanie
Perry, BSN,
RN, CNOR,
CSSM
several preoperative, post-anesthesia
care unit, and OR nurses, all vetted by
One World Surgery to join a Honduran
cohort and work together at a remote,
2,000-acre ranch. The property incorporates
the surgical center, housing, and
other facilities.
" Perioperative care will look different
depending on the setting and location, "
Perry says. Honduras, for example, has
a big problem with rabid dogs. Had she
been deployed to another place where
the State Department advises Americans
not go, she might have worked
in a more urban setting, perhaps one
closer to the patients (although remote
sites often help ensure the safety of the
healthcare team).
Whatever the locale, coping with
austerity can demand more than just
courage and the requisite skills. " In the
US, nurses can expect to use [familiar]
medical equipment and supplies, " Van
Dusen says. " In a far-off deployment,
though, not only are customary mediVan
Dusen offers the example of
lacking medications to prevent wound
infections after the 2021 earthquake
in Haiti. " After the wound was cleaned
with soap and water, we covered it in a
layer of honey to prevent infection, " she
recalls. Military nurses also have a long
legacy of out-of-the-box thinking. In one
notable example, Vietnam War medics
found Crazy Glue was sterile and closed
wounds instantly. By preventing injured
soldiers from bleeding out during medevac
to hospital ORs, the adhesive dramatically
improved their survival odds.
The best prepare for the worst
Faced with injuries ranging from blast
and gunshot wounds to burns and orthopedic
trauma, military nurses commonly
have trauma care (TNCC) and
various advanced life support certifications
(ALS, PALS, ABLS, etc), says Peter
Graves, DHA chief of media operations.
As for civilian deployments, which
OR and perioperative protocols nurses
must train for depends on the nature of
the incident or disaster. " If it's an earthquake,
for example, nurses can expect
to see many crush-type injuries that
could require stabilization of a limb with
internal or external fixation and amputations,
which we saw a lot of after the
earthquake in Haiti, " Van Dusen says.
Although on-site preparation may
be available, Van Dusen recommends
training before a deployment. The Federal
Emergency Management Agency
(FEMA) Center for Domestic Preparedness
(CPD), which focuses on trainwww.ormanager.com
http://www.ormanager.com

orm_february-2024

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