By Carolyn Crist

(Reuters Health) – U.S. nurses may not receive adequate training in how to care for patients during a nuclear event or radiation emergency, a nationwide survey of nursing schools suggests.

More than three-fourths of nursing school administrators and faculty who participated said their curriculum included no training or less than one hour of training on nuclear emergency preparedness, researchers report in the journal Disaster Medicine and Public Health Preparedness.

“We’re looking at how to make sure the American health care system is robust and optimized for a disaster event, which includes making sure the workforce has the knowledge, skills and abilities to understand how to respond,” said lead author Tener Veenema of the Johns Hopkins School of Nursing in Baltimore, Maryland.

Public health emergency preparedness programs have grown since the nuclear power plant accident in Fukushima, Japan, in 2011, and disastrous hurricanes such as Irma, Harvey and Maria in 2017, Veenema’s team writes.

About 3 million people in the U.S. live within 10 miles of a nuclear power plant, the authors note, which puts them directly within the path for exposure should an accident occur.

“Nurses have learned how to respond to natural disasters, terrorist attacks involving mass casualties and large-scale infectious disease outbreaks,” Veenema told Reuters Health in a phone interview. “Each event requires different knowledge and skills, and the same is true for nuclear and radiation events.”

In May 2018, the study team sent surveys to 3,301 nursing school administrators and faculty whose schools belonged to the American Association of Colleges of Nursing or the Organization for Associate Degree Nursing Schools and Programs.

The questionnaires asked about the preparedness content included in nursing programs, radiation response plans and the perception of risk around these events. Based on ZIP codes, the study team also analyzed respondents’ proximity to nuclear power plants, nuclear waste and nuclear research facilities. They focused primarily on the “ingestion” emergency planning zone around each nuclear power plant, which the U.S. Nuclear Regulatory Commission designates as about 50 miles from the reactor site.

Of the 679 individuals who responded to the survey, 75% said their nursing curriculum taught zero or less than an hour of radiation and nuclear emergency preparedness content. The primary reasons given were: inadequate time in the curriculum; the topic isn’t mandated to be taught; there were no qualified faculty in the program to teach it; and no perceived risk of this type of event in the area.

One in three respondents said the topic wasn’t relevant to their school or there was no perceived risk in their area. Based on ZIP code, however, researchers calculated that 295 of the respondents were located within an emergency planning zone, and about half didn’t realize they were within 50 miles of a nuclear power plant.

“This is a patient safety and quality issue,” Veenema said. “If nurses, or any sector of the healthcare workforce, don’t understand proper responses strategies, triage, decontamination, and personal protective equipment, they can’t help others and they can’t keep themselves safe.”

Radiation or nuclear content curricula would need to be developed by experts, made available to schools for free and be a required part of the curriculum, respondents said.

Veenema, who was a nurse scholar-in-residence at the National Academy of Medicine in Washington, D.C., at the time of the survey, is part of a group now holding national workshops at the Academy to train nurses.

About 13% of schools reported having a radiation or nuclear emergency management operations plan, and 6% had tested their plans or run drills.

“The only way to mitigate a poor response to a disaster is to simulate it and train ahead of time,” said Laura Livingston, director of Texas A&M Health Science Center’s Clinical Learning Resource Center in Bryan, Texas. Livingston, who wasn’t involved in the study, has coordinated the center’s Disaster Day, which mimics emergencies such as explosions, hurricanes and wildfires and how nursing students should respond.

“The challenge with a radiological disaster is preventing further exposure and reducing the radiation spread from person to person,” Livingston said in a phone interview. “Nurses don’t learn much about this, so having some exposure to it during a simulated training could be helpful.”

SOURCE: Disaster Medicine and Public Health Preparedness, online June 13, 2019.