INTERNATIONAL NURSING MEXICO CITY EMERGENCY NURSES RESPOND AFTER SEPTEMBER 2017 EARTHQUAKE Author: Gerardo Jasso Ortega, RN, Mexico City, Mexico Section Editors: Nancy Mannion Bonalumi, DNP, RN, CEN, FAEN, and Pat Clutter, MEd, BSN, RN, CEN, FAEN n September 19, 2017, a magnitude 7.1 earthquake struck central Mexico, on the thirty-second anniversary of the 1985 earthquake that killed more than 10,000 people and injured more than 30,000. 1 Just hours before the quake struck, citizens across Mexico participated in earthquake drills in remembrance of that event. Mexico is prone to strong earthquakes because of its location where one part of the earth’s crust is slowly sliding under another. Over time, the stress and friction between the slabs is released in the form of an earthquake. 2 In the immediate moments after the earthquake, people ran into the streets, and others leapt into action, assisting the wounded and digging at the rubble from toppled buildings, using bare hands or any objects they could find in a desperate search against time for survivors. Not surprisingly, emergency nurses were part of the response. This description of the Mexico City response highlights not only the heroism of the nurses but identifies the opportunities to improve how the Mexican emergency care system supports the larger disaster response. The first patients began to arrive at local hospital emergency departments within minutes after the earthquake ceased. Some emergency departments received a radio notification from the emergency medical services (EMS) providers before patients began to arrive, but several emergency departments received no notification of the extent of the damage by the earthquake or the number and types of patients they could expect to receive. In Mexico, emergency medical services responders will often self-dispatch, and following the earthquake, it was no different. Providers from other jurisdictions, wanting to be helpful, appeared at the scene and transported patients to hospitals, sometimes without coordination or communication with local officials. O Gerardo Jasso Ortega, Emergency Nurse Specialist, Nurse Educator and Nurse Manager at Social Security Mexican Institute (IMSS), Hospital General de Zona 48, in Mexico City, Mexico, is President of Asociación Mexicana de Enfermeria en Urgencias (AMEU). For correspondence, write: Gerardo Jasso Ortega, RN; E-mail: amen_ presidente@yahoo.com.mx or gerardo.jassoo@imss.gob.mx. J Emerg Nurs 2018;44:200-2. 0099-1767 Copyright © 2018 Published by Elsevier Inc. on behalf of Emergency Nurses Association. https://doi.org/10.1016/j.jen.2018.01.005 200 JOURNAL OF EMERGENCY NURSING In addition, many patients took themselves to the emergency department, without any forewarning. Because of interruptions to telephone systems, there was limited communication among hospitals in and around Mexico City and no means for hospital coordination and prioritization of ambulance transfers of patients. Hospitals were unable to learn about the status of other emergency departments and how many patients were being treated at any facility. The public, as well as health care workers, law enforcement, and rescue workers relied on social media, such as Facebook and Twitter, and Internet-based communication tools, such as WhatsApp, to communicate during the initial hours. The limited or incorrect information regarding the number of patients, coupled with telecommunication barriers, made implementation of the hospitals’ disaster plans more challenging in the initial hours after the earthquake. Emergency departments treated both traumatic injuries and medical illnesses related to the earthquake. Brain and spinal trauma, extremity fractures, crush injuries, soft-tissue damage, lacerations and abrasions from falling debris, broken glass, and entrapment in collapsed structures were commonly seen in victims. Rescue workers, especially the volunteers who were not wearing adequate protective gear, also sustained similar injuries in the course of their efforts. The dust and particulate matter raised by the fallen buildings led to respiratory complaints, including dyspnea and exacerbation of asthma and chronic obstructive pulmonary disease among the rescuers as well as civilians. The anxiety and fear felt by those affected produced physiologic and psychological injuries. Chest pain, hyperventilation, and panic attacks were reported among the wounded and survivors, including those who were unable to locate loved ones or learned that they had perished. As with any mass casualty event, the need for blood donations surged. Emergency nurses also contributed by volunteering at blood drives established to collect blood for the victims of the earthquake. The Mexico City hospitals were not immune to the damaging effects of the earthquake. Some facilities lost power, and evacuations were carried out if the building was deemed unsafe to occupy. Emergency departments were set up outside in large open spaces away from the risk of falling buildings (Figure). Using emergency generators to illuminate the work area, staff triaged and treated incoming patients. At a large medical center in Mexico City, critically VOLUME 44 • ISSUE 2 March 2018 Jasso Ortega/INTERNATIONAL NURSING FIGURE Setting up an emergency care area outside the author's hospital. ill patients were carried down in dark stairwells to the meeting point outside the hospital while ambulatory patients were assisted to the stairwells, then to safety. Outdoor makeshift nursing units with rudimentary equipment and supplies provided ongoing care. Hospitals that were found to be structurally sound still struggled to provide care because of disruption to power and water lines. The Neonatal Intensive Care Unit nurses at Centro Medico la Raza, located on the 12th floor of that facility, alternated 15-minute shifts to ventilate fragile infants manually until electrical power was restored. Around Mexico City, unaffected buildings became gathering places for families and friends near sites where efforts to locate survivors continued. Nurses set up sidewalk clinics to tend to the needs of those assembled, providing care and comfort as best they could. Lessons Learned Approximately 260 people lost their lives in the September 2017 earthquake, a fraction of the loss suffered after the 1985 event. Safer buildings, citizen preparedness, and a stronger health care system made that possible. But there are still many weaknesses in the Mexican disaster- response program. In the day after the quake, rescue efforts were chaotic and disorganized. Although some sites required volunteers to register with identification and protective gear such as hard hats and boots, nurses wearing only their white uniforms with no ID and without having registered, responded to the scene of building collapses. Unfortunately, March 2018 VOLUME 44 • ISSUE 2 in Mexico, registered nurses are not considered as “first responders” and therefore have little or no training in preparation for disaster-management efforts. The focus of emergency preparedness in Mexico has been on densely populated urban areas; however, there is a danger associated with neglecting rural or unpopulated areas. The September 19, 2017 earthquake was a wake-up call and sparked a reassessment of hospital disaster preparedness. Plans and preparedness do not occur overnight or, in some cases, even in decades. Many Mexican hospitals still struggle to achieve adequate preparedness. Nearly 90% of hospitals in the declared disaster area reported experiencing substantial challenges in responding to the emergency, according to a recent report from Mexico's National Center for Prevention of Disasters (CENAPRED). 1 Echoing many of the issues faced in previous natural disasters, “These challenges represented a range of interrelated problems from infrastructure breakdowns, such as electrical and communication failures, to community collaboration issues over resources, such as transportation, hospital beds, and public shelters.” 3 Being prepared for a natural catastrophe, especially when there are known risks for events such as earthquakes, means having a plan in place to deliver high-quality nursing care under challenging conditions. Increasingly, emergency response planners have come to realize an essential part of preparedness is ensuring that hospital personnel are safe and healthy. Not only do employers have an obligation to protect their employees, the success of every other part of the emergency plan WWW.JENONLINE.ORG 201 INTERNATIONAL NURSING/Jasso Ortega depends on having healthy and motivated employees in all essential roles. Lessons learned are clear: keeping employees properly trained, safe and healthy is one of the highest priorities when responding to a major incident. As the president of the Asociación Mexicana de Enfermeria en Urgencias (AMEU), one of my responsibilities is to network with other emergency nursing associations, such as ENA, to bring best practices and educational opportunities, such as the Trauma Nurse Core Course, to our members to provide the highestquality care to our patients. In addition, having emergency nurses become health care disaster certified expands and integrates the influence of emergency nursing into local, regional and national disaster management operations. 202 JOURNAL OF EMERGENCY NURSING REFERENCES 1. Central Mexico earthquake kills more than 200, topples building. http://www.cnn.com/2017/09/19/americas/mexico-earthquake/index.html. 2. Why Mexico is so prone to strong earthquakes. https://www.nytimes. com/2017/09/20/world/americas/mexico-earthquakes-explainer.html. 3. http://www.cenapred.gob.mx/es/documentosWeb/Tertulias/ Presentacion_Dr_Valdes.pdf. Submissions to this column are encouraged and may be sent to Nancy Mannion Bonalumi, MS, CEN, FAEN nbonalumi@comcast.net or gerardo.jassoo@imss.gob.mx or Pat Clutter, MEd, BSN, RN, CEN, FAEN prclutter@gmail.com VOLUME 44 • ISSUE 2 March 2018
