A report about the first meeting on the role of intensive care units nurses in emergencies and disasters in Iran

According to the human consequences caused by emergencies and disasters, the health system especially hospitals, are among the first places that are influenced by this events. Continuity of service provision by hospitals after emergencies and disasters is one of the important issues that should be taken into consideration by all people and authorities. For hospitals, it is necessary to promote their preparedness to deal with emergencies and disasters prior to their occurrence(1, 2). In this regard, joint accreditation commission for Healthcare Organizations emphasizes safety and vulnerability assessment of healthcare organizations in three structural, non-structural, and managerial domain(3, 4). In each hospital, disaster preparedness of different units consistent with the services they provide is very important. Over last 70 years, the development of modern intensive care units with high costs has increased the survival rate of patients with threatening conditions(5). Intensive care units are key units in which patients that are exposed to high risks and threatening conditions receive care. Patients in these units receive services under the surveillance skilled and trained healthcare team. According to the type of hospitalized patients, equipment, and intensive care level, these units are more vulnerable when emergencies and disasters occur. Before the incidence of emergencies and disasters, intensive care units should be prepared for potential events, because when these events occur, the need for special and vital cares intensively increases. For this reason, nowadays, while planning for hospital disaster preparedness attention to intensive care unit is crucial. (6). Most of intensive care units have normal functional capacity and this level is very low at the time of emergencies and disasters where limitations include space, transfer of patients, triage of patients, trained human source, and lack of allocation of medical and structural and non-structural safety equipment. For this reason, while  in preparedness planning for preparedness against emergencies and disasters, planners should check intensive care units in terms of structural and non-structural as well as managerial preparedness. Planners know that despite preparedness, reaction at the time of emergencies and disasters is not 100%, but accurate planning by intensive care units enables the personnel to efficiently react against these events. The results of previous studies on the preparedness of intensive care units in response to emergencies and disasters shows that unsuitable design of units, equipment, and lack of training for the healthcare team are among the main reasons for inadequate preparedness of these units at the time of disasters(6, 7). A limited number of studies are conducted on the assessment of safety and preparedness of intensive care units. At the time of emergencies and events, lack of space and equipment in intensive care units are two fundamental problems. At this time, whole parts of the hospital should become intensive units and to achieve this purpose, authorities should have suitable planning before the incidence of emergencies and disasters. For this planning, it is necessary to assess the potential vulnerability conditions and then, the potential capacity for hospitalized patients and their transfer to other centers as well as human sources management should be determined(7). Despite the design of hospital safety assessment equipment and efforts for the preparedness of healthcare team against emergencies and disasters from 2008(8), the researcher has not found any educational package or instrument that has assessed safety and preparedness of intensive care units such as ICU and CCU. However, fundamental measures are taken regarding preparedness in dialysis and neonatal intensive care units. In Iran that is among the countries with highest level of emergencies, regarding Sendai priorities and distribution of disaster risk management at different levels of the society, at the international day of the Pastor on May 12, 2018, in the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, with the cooperation of members of intensive group nursing members, healthcare experts in emergencies and disasters and nurses of intensive care units, a one-day meeting entitled “the role of nurses in emergency care units in disasters and emergencies” was held. In this seminar and after an introduction about the position of Iran in emergencies and disasters, the role of hospital and intensive care units in disasters, nurses stated their experiences about different disasters such as Bam earthquake and Kermanshah earthquake and fire in intensive care units and pointed to management by their organization and these functions were discussed. Different factors such as inappropriate equipment management, lack of personnel competency, inappropriate management and leadership, lack of awareness about how to triage patients, lack of proper allocation of sources, lack of fire management, influx of people to get equipment from these units, unsafety of units, fall of devices and equipment, no power and water, excessive presence of personnel in the unit and lack of appropriate management, lack of possibility to replace skilled human sources when needed, lack of attention to the comfort of personnel regarding safety of their family members, and lack of training courses for families about providing care in home during emergencies and disasters were among the most important experiences of nurses who participated in this meeting. In this meeting, suggestions such as holding workshops in intensive care units, establishment of an exclusive research center in this field, establishment of an exclusive journal, research designs, experiences of people in this field, and designing an instrument to check the safety of intensive care units were proposed. Also, one of the most important suggestions in this meeting was holding international seminars and meetings to exchange experiences from different countries about the preparedness of intensive care units against emergencies and disasters.