An improvised nuclear device (IND) is considered by the DHS to be the most catastrophic terrorist incident that could befall the United States, causing severe economic damage, extensive property damage, and enormous loss of life. Effective response to an IND is best accomplished with preparation including emergency operations plans (EOP) specific to an IND and training for staff on how to respond. The literature documents several areas of weakness in U.S. health services' preparation that affects entire communities and puts lives at risk. The purpose of this study was to assess the strengths, weaknesses, and gaps in Detroit, Michigan hospitals' EOP for responding to an IND terrorist attack. The conceptual framework used systems theory to look at how an event's complex individual components work as parts of a larger whole. Specifically, the interconnections that the individual parts of an event have on the outcome were assessed as means of evaluating the IND EOP that Detroit area hospitals have in place. This qualitative study consisted of an interview approach with the emergency management representatives of Detroit hospitals responsible for EOP development. Data analysis was completed using categorization based on research questions to look for commonalities and trends. This study revealed gaps that the 5 participating Detroit hospitals have in their preparation, training, and staff knowledge in response to an IND. Implications for positive social change, at local and national levels, include creation and dissemination of an improved model for disaster planning and training in the hospital setting, which correlates to improved community response and community care for health service organizations and throughout health services as a whole.

Bakgrund: För att följderna av en allvarlig händelse i samhället ska minimeras åligger det varje region att ta fram en katastrofmedicinsk beredskapsplan och planera sjukvården så att katastrofmedicinsk beredskap upprätthålls. Vid en allvarlig händelse aktiveras en lokal katastrofmedicinska beredskapsplanen för respektive sjukhus. Ledningsansvarig sjuksköterskapå akutmottagningen är ofta den som tar emot larmet om en allvarlig händelse och aktiverar katastrofplanen.  Syfte: Granska och jämföra svenska regioners katastrofplaner för att belysa vilken roll den ledningsansvariga sjuksköterskan på akutmottagningen kommer få vid en allvarlig händelse. Metod: Deskriptiv tvärsnittsstudie med kvantitativ ansats. Insamling av enkät och styrdokument från den största akutmottagningen i varje region.  Resultat: Majoriteten av akutmottagningarna (60%) hade inga formella krav på tidigareerfarenhet och utbildning för ledningsansvarig sjuksköterska. Utbildning och övning i ledarskap och katastrofberedskap för den ledningsansvariga sjuksköterskan gavs, men i en begränsad omfattning. Vid en allvarlig händelse delges den ledningsansvariga sjuksköterskanmånga betydelsefulla arbetsuppgifter och ansvarsområden utifrån akutmottagningarnas lokalakatastrofplaner. Endast 10% av de regionala katastrofplanerna ger en utförlig beskrivning av den ledningsansvariga sjuksköterskans funktion.  Slutsats: Ledningsansvarig sjuksköterska utgör en central funktion vid en allvarlig händelse. Det bör ställas höga krav på kompetens och funktionen behöver lyftas fram i regionernas katastrofplaner, vilket i nuläget brister i många regioner. Ledningsansvarig sjuksköterska utan tillräcklig utbildning och erfarenhet riskerar att bli en svag länk i systemet kring hela hanteringen av en katastrofhändelse. Något som kan ge konsekvenser i form av en icke fungerande akutmottagning vilket i sin tur kan påverka resten av vårdkedjan och utgöra en belastning på andra samhällsbärande funktioner. / Background: To minimize the consequences of a major accident or disaster, every region has to develop an Emergency Operations Plan and ensure the health care system is able to provide high-quality care during all circumstances. In case of a major accident or disaster, a local emergency response plan is activated at each hospital. The charge nurse is usually the person who receives the alarm call and activates the local emergency plan in the event of a disaster.  Aim: To review and compare Emergency Operation Plans in Swedish regions to highlight the role of the charge nurse in the event of a disaster.  Study design: The study was performed as a quantitative cross sectional study, using questionnaires and a collection of regulatory documents as a data collection method, and descriptive statistics for analyzing the data.  Results: A majority (60%) of the emergency departments did not express any formal requirements in the form of higher education or previous experience for a charge nurse. Education and exercise in leadership and disaster management was provided, but to a limited extent. In the event of a disaster, many important tasks and areas of responsibility are assigned to the charge nurse, according to the local emergency plans. Only 10% of the regional Emergency Operation Plans provide a detailed explanation of the charge nurse function. Conclusion: The charge nurse plays a pivotal role at the emergency department in the event of a disaster. The requirements for the position should be high and the position needs to be highlighted in the regional Emergency Operation Plans. A charge nurse lacking enough education and experience may become a weak link in the chain of disaster management. This may result in ramifications in form of a dysfunctional emergency department affecting otherparts of the hospital and society.