Public Health Nursing and Public Health’s Role with Anthrax

Public Health Nursing and Public Health’s Role with Anthrax

by Patsy McCall, MSN, RN, CNA

Public health department staff in Tennessee has been concerned for many years about the threat of disasters in Tennessee. This awareness includes a concern regarding earthquakes from the Madrid fault zone through Tennessee, the threat of a release of radioactivity at our state’s nuclear power plants, as well as other natural disasters such as tornados and floods. From concerns such as these, the Tennessee Emergency Management Agency brought together many state agencies and the American Red Cross during the 1980s to develop a statewide emergency management plan. State agencies included the Tennessee Department of Health–Emergency Medical Services, Department of Health–Health Care Services, Department of Commerce and Insurance–State Fire Marshal, Department of Safety–Tennessee Highway Patrol, Tennessee Bureau of Investigation, Department of Correction, Department of the Military, and Department of Mental Health and Mental Retardation.

The plan delineates each department’s role during a disaster. Public health’s role includes preventing outbreaks of a disease during a disaster, assisting with controlling possible environmental problems such as contaminated water and food, monitoring the disposal of sewage, setting up surveillance to monitor health such as clusters of outbreaks of disease, educating the public on health issues and health prevention, staffing clinics and assisting hospitals with capacity building by deploying needed personnel.

The role of public health nurses during a disaster became more obvious after the Oklahoma bombing in 1995. Oklahoma’s public health nurses played a major part during this disaster. They set up on-site clinics, gave immunizations, and counseled those in need. After learning of the role public health nurses played after the Oklahoma bombing, it became apparent public health nurses in Tennessee needed to enhance their disaster skills. For the past several years, first aid courses plus disaster courses provided by the Red Cross were offered to public health nurses in Tennessee. Epidemiology and bioterrorism classes became more available, and job plans were revised so that each public health nurse had the authority to participate during a disaster when called upon by their local and regional supervisor.

The Tennessee Department of Health has been focused on bioterrorism preparedness for the past couple of years. Department staff has worked with the Centers for Disease Control and Prevention, the Tennessee Emergency Management Agency, law enforcement officials, emergency personnel, and others to develop a response plan in the event of a biological or chemical attack. This plan was integrated into the State’s overall emergency management plan in 2001.

When the anthrax scare hit our nation, Tennessee set a plan into motion. A policy was written delineating the role of public health. The policy stated public health nurses and health officers would provide information to medical providers and the community regarding bioterrorism and anthrax, be prepared to investigate cases, and provide prophylactic medication if necessary. The health departments furnished information to health care providers and the community on how to recognize the symptoms of anthrax, decontamination procedures, measures to take in handling suspicious letters and packages, instructions on chain of custody of laboratory specimens, and reporting responsibilities of individuals handling these specimens and treatment regimen.

Public health nurses and health officers established a system for proper communication of such incidents and established a database. Health department nurses, health officers and other staff worked with law enforcement, the FBI, and state laboratory personnel to assist with this chain of communication to calm the fears of individuals impacted by the anthrax scare. The State Laboratory began accepting anthrax specimens from law enforcement seven days a week for twenty-four hours a day. Local public health nurses and health officers received notification of laboratory results and communicated these results to law enforcement personnel who in turn communicated the results to those impacted by the anthrax scare.

To date, 1340 specimens, all negative, have been tested for anthrax and other biological agents in Tennessee. Seventy of the ninety-five counties in Tennessee have experienced at least one scare. Public health nurses and health officers continue to work with law enforcement, educate the community, monitor the threats, and investigate and report clusters of illness with possible association to bioterrorism. Because public health nurses and health officers will be on the front lines of investigating and treating any positive results from a bioterrorism attack, they continue to stay on heightened alert for signs and symptoms of anthrax and reports of clusters of illness associated with bioterrorism.

Patsy McCall is the director of public health nursing for the Tennessee Department of Health and is a member of TNA in Music City District 3.