By Debra Wood, RN, contributor
In response to multiple oversight reports indicating an inadequate response to Hurricanes Katrina and Rita by the U.S. Public Health Service Commissioned Corps, this uniformed service has revamped its deployment strategies and stepped up training.
“In the Commissioned Corps, there has been aggressive work done on restructuring the emergency preparedness response,” said Rear Adm. Carol A. Romano Ph.D., RN, FAAN, assistant secretary for health and chief nurse officer of the Corps, in an email response to questions. “A tiered approach to response with pre-identified multidisciplinary teams, focused training, and deployment criteria and roles are among the major changes.”
The Office of the Inspector General reported that Corps officers provided critical support during the two 2005 hurricanes, but the Commissioned Corps failed to meet some needs, especially nursing, mental health and dentistry. The report cited officers lacking adequate skills in administering immunizations and providing primary, acute and emergent care.
Corps public health officers normally work in federal government agencies, such as the Centers for Disease Control and Prevention, the National Institutes of Health or the Indian Health Service. When a disaster or other public health event occurs, they respond.
“The Corps serves a pivotal role post-9/11,” said Capt. David Rutstein, M.D., director of the Office of Force Readiness and Deployment in the Office of the Surgeon General. “The thing that unites them is their ability to provide a response of human assets to assist with a population’s and the government’s needs.”
The inspector general’s report highlighted deficiencies in officer preparation, deployment logistics and field operations. Some of the agencies where the Corps officers work full time were unwilling to let them deploy. The inspector general recommended more effective officer training, improving deployment systems, streamlining travel arrangements to the scene and staggering deployments to ensure continuity of operations.
“It was not a lack of will in Katrina or desire but the scope of Katrina had never been seen previously,” Rutstsin said. “If there was any benefit to Katrina, it was bringing the reality of how devastating something like this can be home to the American population, who perhaps prior to Katrina felt disasters of somewhat Biblical proportions happened elsewhere.”
Since receiving reports from the Inspector General, the White House and Congress, the Corps has restructured its emergency response program, instituting 25 teams, five each trained in five specific areas. One set of the five teams is on call once every five months. In addition, individual officers may be deployed later to provide relief to team members already on the scene.
The rapid deployment force provides acute care and rapid needs assessments. Incident response coordination teams are responsible for logistical support, field office coordination and liaison activities. The applied public health team offers health education to an affected area, ensures food and water supply safety, and can step in to assist local public-health departments. The mental health response teams provide psychological services to victims and responders. And the emergency management group works at the Secretary of Health and Human Service’s operations center to manage national responses.
Corps nurses received additional training this summer at Camp Bullis, near San Antonio, Texas. The Office of Force Readiness and Deployment, the Department of Defense, Texas A&M Health Science Center, and UCLA helped to develop the curriculum.
“Training consists of classroom presentations and drills, culminating in a large field exercise under simulated conditions,” Romano said. “Class content is aimed at the specific response team type, with some material overlapping all teams.”
Nurses also take a basic Federal Emergency Management Agency independent study course. In addition, the chief nurses on the rapid deployment forces are given time during the exercise to mentor their nurses.
“As these teams are likely to deploy together, this training is intended to facilitate functional training and communication,” Romano said.
The inspector general found that once on the ground in the 2005 hurricane zone, some of the officers lacked communication devices and other basic tools. Many officers personally incurred mission-related expenses and were not promptly repaid.
Now, team leaders on each team have been issued credit cards that can be used once a disaster has been declared. In addition, the Corps officers will carry credit cards from their home agencies.
“I definitely think we are better prepared,” Rutstein said. He offered as an example that the Corps pre-staged teams in Texas as Hurricane Dean approached in August 2007, in case the storm veered north.
Rutstein said although there are more nurses than any other profession serving in the Corps, the uniformed service needs more nurses.
“Nurses are extremely valuable to all of the teams as well as individual officers to be deployed,” Rutstein said. “Physicians and nurses, those two categories are essential for growth of the Corps and for the health and well-being of the nation.”
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