News
2001; Lippincott Williams & Wilkins; Volume: 101; Issue: 10 Linguagem: Inglês
10.1097/00000446-200110000-00017
ISSN1538-7488
Autores ResumoAS WE WENT TO PRESS... Nurses, and the Nation, Respond to Disasters Terrorist attacks on the World Trade Center and the Pentagon initiate unprecedented efforts. When disaster struck on the morning of September 11, nurses and physicians at trauma centers in New York City and Washington, DC, knew the procedures and protocols to implement. What they didn’t know was the magnitude of the damage—or the response the tragedies would generate nationwide. At New York’s Bellevue Hospital, ED head nurses Marion Machado, RN, and Joyce Buffolino, RN, had no need to call in extra staff; emergency personnel who were off duty or home sick called to say they were on their way. Within the hour, Bellevue was inundated with workers: not only were there nurses and physicians from other departments, but nurses arrived in buses from other New York City hospitals—including Mt. Sinai Hospital, Metropolitan Hospital Center, and Queens Hospital Center. Machado said the hallways were “elbow-to-elbow with people in scrubs”; Buffolino estimates about 800 people responded. Bellevue’s first patient from the disaster arrived on his own. After debris from one of the collapsing towers caused a knee injury, he simply hailed a taxi. Bellevue’s second patient, however, was more representative of what was to come: a firefighter, who had responded to the initial assault on the towers, had been killed when hit by a falling body. A chaplain who had been administering last rites to the firefighter on the scene also died after being struck by falling debris. FIGUREFigure 1: Nurses and other medical staff inundated New York–area hospitals in response to the World Trade Center attacks.Patients came, though sporadically, and not in the numbers expected. The injured were mostly rescue workers, not office workers, and the injuries were largely fractures, burns, and inhalation and eye injuries from the smoke that blanketed lower Manhattan. From the time of the disaster until midnight, they treated approximately 220 patients. Personnel soon became frustrated when no more patients arrived—and then saddened when they realized what that meant. Buffolino was also quietly managing her own fears, until she finally heard that her sister who worked at the World Trade Center was safe. Machado went to the “ground zero” triage station on Thursday, two days after the attack. She said it was “surreal and still had a big cloud of smoke.” She noted that the air quality was very poor, and that much of the emergency care there consisted of eye washings, suturings, and nebulizer treatments. She also said that many rescuers refused to leave the area; after being treated they returned immediately to the search for victims. Both Buffolino and Machado said they never would forget the tremendous support they received from nurses everywhere—they even received a faxed message of support from a hospital in New Zealand. At Saint Vincents Medical Center in New York, the trauma center closest to the World Trade Center, the situation was much the same. Trish Tennill, RN, had witnessed from her rooftop the attack on the twin towers. “I live just three blocks down the street,” she said, “and my brother called me, screaming, and told me to go up and look at the towers. I got up there just in time to see the second plane hit.” Even though it was her day off, she said, she knew she had to don her scrubs and get immediately to the hospital. Her shift that day stretched from 9:45 am until 11:30 pm . According to Richard Westfal, representative of the medical center, the facility saw 361 patients in the first 24 hours after the attacks, four of whom died; 58 of the 361 were paramedics, firefighters, and police officers. Westfal said that the facility had triple its usual staff in its ED, and had set up three “mental health hotlines” to address the huge psychological fallout of the tragedy. FIGUREFigure 2: Trish Tennill, RN, at Saint Vincents Medical Center in New York, on September 12, the day after the attacks.For nurses like Tennill, the stresses were myriad: when there had been a scare that a nearby medical center had been attacked, “no one ran,” Tennill said. “Everyone knew they had to stay right where they were.” Also, she said, many of the medical center’s nurses are married to firefighters. So far, all had been accounted for. And the patients, when they came, were extraordinarily traumatized. “One woman with pulmonary contusion kept saying over and over ‘Am I going to die? Am I going to die?’” Support came in many forms as well. Area restaurants and residents donated full-course meals, bags of ice, and drinks for Saint Vincents’ emergency workers. Tennill also found comfort, she said, in the opportunity to help nurses who’d traveled from other areas. Two nurses spent the night of September 11 at Tennill’s apartment. And neighbors have reached out as well. “It’s been amazing,” Tennill said. After a pause, she added: “Well, this is New York. No one’s talking to each other, but everyone’s really friendly.” At Virginia Hospital Center–Arlington, in Virginia, where over 40 injured survivors of the Pentagon attack were treated, assistant patient care director Margo Buda, RN, reports that “the thing that amazed me the most was the preparedness and quick response by everyone. Residents, medical students, off duty staff, and even RNs not on staff—all were so quick to arrive prepared to help.” Most of the patients arrived between 10 am and 12:30 pm , suffering severe burns and inhalation injuries. Several burn victims were also treated at Washington Hospital Center and Walter Reed Army Medical Center. After the first wave, most of the patients seen were firefighters injured during the rescue effort. FIGUREFigure 3: Saint Vincents Medical Center in Greenwich Village, the trauma center nearest to the World Trade Center, was pandemonium on the day after the disaster, with volunteers, medical staff, and food donations competing for space outside the hospital.Buda also remarked on the incredible support they received: nurses who had recently resigned arrived with food and offers of help; the community sent food and water and soda; embassies in the area sent roses, and an Arizona hospital sent pizza. Many of the nurses were invited to attend the prayer service at the National Cathedral on Friday led by President Bush. —Maureen Shawn Kennedy, MA, RN, news director, and Joy Jacobson, managing editor Trial of Labor After Cesarean Section Risk of uterine rupture increases—especially with induced labor. Since the late 1980s, when the rate of cesarean section in the United States peaked at 23%, women who’ve had a previous delivery by cesarean section have been encouraged to undergo a trial of labor during their next deliveries. Currently, about 60% of U.S. women who’ve had prior cesarean sections undergo a trial of labor in a subsequent pregnancy. A large study now reveals, however, that this significantly increases the risk of uterine rupture. More than 20,000 women in Washington State were enrolled in the study: women whose first singleton infants were delivered by cesarean section between 1987 and 1996 and who had second singleton infants during the same period. Compared with those who had repeat cesarean sections, the risk of uterine rupture in the second delivery tripled in women with spontaneous onset of labor. The risks were nearly five times as great in women whose labors were induced without prostaglandins and more than 15 times as great in women whose labors were induced with prostaglandins. TABLETable: Rates of Uterine Rupture After Prior Cesarean SectionIn an editorial accompanying the study, Michael Green, MD, recommended that all pregnant women who’ve had a previous cesarean delivery be told of the increased risk of uterine rupture associated with labor, and that the safest method of delivery for these women is elective cesarean section. Mary Ann Shah, MS, CNM, FACNM, president of the American College of Nurse-Midwives, said that women who seek a trial of labor after cesarean section must be informed of its risks and benefits as well as those of repeat cesarean. “The midwifery model of care involves rigorous maternal and fetal monitoring throughout labor, striving for a safe and satisfying birth outcome that, if possible, avoids unnecessary surgery. However, transfer to a physician’s care for a repeat cesarean may be deemed necessary if labor does not progress satisfactorily or if an untoward event ensues—a course of action that the patient should agree to in advance.” Lydon-Rochelle M, et al. N Engl J Med 2001;345(1):3–8; Greene MF. N Engl J Med 2001;345(1):54–5. FROM THE NATIONAL INSTITUTE OF NURSING RESEARCH Aerobic Exercise for HIV-Infected Patients Results of a study are surprising. Researcher Barbara Smith, PhD, RN, FAAN, FACSM, and colleagues from Ohio State University studied the effects of exercise on endurance, weight and body composition, and dyspnea in HIV-infected adults. Study participants in the experimental group completed a supervised exercise program of walking, jogging, or running on a treadmill or track; the control group did not. After 12 weeks, participants in the intervention group showed greater endurance, along with decreases in weight, body mass index, and abdominal girth, with no differences noted in CD4 + cell counts. Smith notes, “When we began our study in 1995 people were concerned that we might precipitate wasting and compromise an already fragile immune system by exercise. This study demonstrated that HIV-infected adults can exercise safely.” Smith BA, et al. AIDS 2001;15(6):693–701. The Politics of Reproductive Health The battle escalates. At the start of his administration, President George W. Bush signed an executive order banning federal funds to international family planning groups that offer abortion or abortion counseling. This set the stage for a host of measures many organizations are decrying as attempts to curb women’s access to family planning services and abortion. Among these measures was the rejection by the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) of a waiver request by the state of Georgia to expand contraception coverage and other family planning services through its Medicaid program. But while it had been suggested that other states’ requests for waivers would also be declined, Department of Health and Human Services (DHHS) secretary Tommy Thompson surprised skeptics by approving such requests from New York and Missouri. According to the Washington Post, Thompson indicated at the National Governors Association annual meeting in August that he expects all pending applications to be approved, adding that he has asked states to broaden their applications to include primary care for all women who seek help. This development may have assuaged some opponents of the Bush administration’s handling of family planning. Nevertheless, critical issues include the House’s approval in April of the Unborn Victims of Violence Act, which would consider harm to a fetus during an assault on a woman a federal crime. a July DHHS proposal to classify an embryo as a “target low-income child” eligible for medical care. the House Armed Services Committee’s rejection in August of servicewomen’s and military dependents’ rights to privately funded abortions, except in cases of rape, incest, and life endangerment. the president’s failed attempt to eliminate contraception coverage for federal employees. “It is the height of hypocrisy,” notes Planned Parenthood president Gloria Feldt, “for a president who opposes a woman’s right to choose to also limit women’s access to the very thing that prevents unintended pregnancies and makes abortions less necessary. It’s time for the attacks on women’s health to stop.” Wanda K. Jones, deputy assistant secretary for women’s health at the DHHS, declined to comment. Adding to the discord is the decision in June by the nation’s Catholic bishops to ban tubal ligations and vasectomies in hospitals affiliated with the Catholic Church. The directive was outlined in the fourth edition of the Ethical and Religious Directives for Catholic Health Care Services.FIGUREFigure 4: The Dutch ship Sea Change left the Netherlands June 11 for Ireland.And while all this debate has been taking place on land, Dutch physician Rebecca Gomperts has circumvented antiabortion laws through her organization, Women on Waves. Founded in May 1999, the organization delivers abortion services on a ship, the Sea Change, outside the 12-mile territorial waters of countries in which abortion is illegal. Since the ship is Dutch and abortion is legal in the Netherlands, Women on Waves is not committing an illegal act. The organization also provides training in family planning and postabortion care to local service providers, contraceptives, counseling, and pregnancy tests and is campaigning to raise public awareness of women’s health issues worldwide. In Memoriam Two noted nurse editors died recently:Dorothy Dennison Nayer, on July 21, in Oakland, California. Dorothy was associate editor of AJN from 1962 to 1973. Mildred Gaynor, in Tampa, Florida. Mildred was the editor of Nursing Outlook from 1953 to 1967. We at AJN extend our condolences to their families.
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