08 August, 2011

Disasters happen: Practice implications and issues

I was invited by the Chief Nurse and Midwifery Officer for Queensland Health to present as a Key Note Speaker at the 4th Passionate about Practice Conference. My presentation outlined some of the practice implications and issues for nurses and midwives during disaster response and recovery. The following provides an overview of the presentation (not word-for-word).

Slide 2: disasters happen
So you’re a health professional, and we know disasters happen. Would you be happy to assist? The vast majority (more than 90%) of the 600 conference delegates raised their hand to indicate that they would assist. Prior to assisting, there might be some questions you would want to ask yourself. These questions might include:
  • What is a disaster?
  • Am I really willing to participate?
  • Am I able to participate?
  • What education have I received?
  • Am I well resourced?
  • What would my role be?
  • What other things do I need to think about?

Slide 3: what is a disaster?
My presentation illustrated the different between:
  • Hazards
  • Risks
  • Events
  • Impact
  • Damage
  • Disasters
I outlined the difference between disaster health issues (disasters that effect health, health infrastructure and health workforces), in comparison to disasters effecting social determinants of health (damage to transport infrastructure, water supplies or shelter).

Slide 4: what is a disaster?
I outlined some disasters that have occurred in Australia, requiring a health response.

Slide 5: what is a disaster?
Additionally, I outlined the various commonwealth health responses, in which the National Incident Room has been activated.

Slide 6: Are you willing to participate?
So you know what a disaster is, and we have discussed some examples of disasters. Are you willing to assist? Once again, the vast majority (more than 95%) of the 600 conference delegates raised their hand to indicate that they would assist.

You would probably get a similar reaction from your staff in your ward / department. Why? Because nurses want to assist and help others. Following the Pacific tsunami in 2009; this was the case in my emergency department. Most nurses; newly registered and senior nurses, and administrative staff said yes, they wanted to assist! Are these nurses and staff naively willing? Do they really understand what it means to participate in the health response to a disaster?

I outlined a research project of emergency nurses, in which they discussed the things that effect willingness (this slide illustrates the themes and subthemes effecting willingness, such as family, work culture, known versus unknown biological agents, etc...).

Asking the conference delegates again – would they be willing to assist in a disaster, the majority (more than 90%) indicated they would not.

Slide 7: are you able?
So, you might be willing, but are you able? Ability may be influenced by various factors, such as:
  • Ability to get to work - in terms of transport (car washed away)
  • You might have transport, but no transport infrastructure (road cut-off by water)
  • You might have transport infrastructure, but it might be congested
  • You might want to defend your own home

Slide 8: What education have you received?
When asked if the conference delegates had received some education or training in disaster health, about half indicated they had.

My presentation outlined the disaster education provided in undergraduate programs – according to a recent survey of Australian Universities by Usher and Mayner (2011), very little occurs. I suggested that this leaves clinical institutions with the responsibility to train and educate staff about their role in disaster health.

Of the conference delegates who had received some disaster education or training, the majority indicated that they had received this during in-service type sessions. However, we know (at least anecdotally) that in-service education topics are concerned with the day to day business of the ward / department (eg: managing their daily patient population) or new technologies / equipment in the workplace. Additionally, it is sometimes difficult to get everyone (or sometimes anyone) to an in-service session.

Perhaps disaster health education for nurses and midwives should be offered at a tertiary postgraduate level. It does at some universities embedded within public health or emergency health courses (Monash, Queensland University of Technology, and James Cook University); however, these programs are commonly multidisciplinary and non nursing specific. Assuming disaster health is embedded in nursing specialty tertiary postgraduate programs, perhaps it is offered in emergency nurses programs? In a recent survey of Australian tertiary postgraduate emergency nursing programs, this was found to be true, with 7/10 programs discussing disaster health. However, across the programs, the type and duration of education differs. Is there a need for consensus in disaster health education? Or the implementation of a proposed national framework as suggested by some (FitzGerald, et al., 2010)?

We know that some nurses receive education via ICS and MIMMS type programs. However, these and other programs don’t necessarily replicate the realities of disaster work. For example, some programs focus on mock CBR, random multiple casualty incidents or terrorist related disasters, whereas, the reality is that Australian nurses assist in bushfires and extreme weather events.

Slide 9: Are you well resourced?
I outlined the need to be well resourced, self-sufficient and self-sustaining during disaster response and recovery. However, this can be influenced by:
  • Delayed versus non-delayed disasters: the given time to plan and organise resources prior to impact of an event
  • We know that disasters happen out of hours: both Canberra and Black Saturday bushfires occurred on a Saturday. Out of hours, health services have less human resources, and commonly newly registered nurses are in leadership roles during this time
  • In the initial response: nurses ‘pack the car’ full of trauma and resuscitation equipment, but use little, as they perform primary health roles
  • Defence are best resourced, self-sustaining and self-sufficient in a humanitarian response

Slide 10: What would your role be?
I argued that there is a perception that disaster health is of high-level acute clinical care, primarily portrayed by the media. Following research relating to the Black Saturday and Victorian bushfires, the role of the nurse were identified as being:
  • Clinical care: high amount of surgery in Haiti versus minimal acute clinical care in Australian fires and extreme weather events
  • Emotional supporter
  • Coordinator of care: similar to a hospital coordinator type role
  • Problem solver
The picture of the koala illustrates that CFA personal do more than fight fires. Perhaps nurses do more than a clinical role? However, we are still in the early stages of understanding what nurses do.

Slide 11: What other things should you think about?
I outlined other things to think about, such as, if you volunteer to assist:
  • Don’t become a disaster tourist – the Haiti experience is a good example of this
  • Respond with a Government or registered NGO, ensure that you are invited into a foreign country, are self-sufficient and self-sustaining
  • Consider your employer, what do they offer in terms of incentives, or support? What does your nursing and midwifery enterprising bargaining agreement include? Only 3/8 Australian nursing enterprising bargaining agreements mention nurses assisting in disasters. This is commonly ambiguous, relating to the nurses role volunteering with the RFS or SES, not necessarily in a disaster health capacity
  • I spoke about ‘a list’ or ‘the list’ to register to assist in a disaster. These vary from state-to-state, health service-to-health service and hospital-to-hospital. They are somewhat haphazard and vary
  • Response versus recovery: response is media attractive, however, recovery continues for months or years. Save your energy and volunteer to participate in the recovery period
If you want to donation to a disaster, give money as this gives back to the local economy, and saves volunteer time in sorting through donated items of clothing and bedding, which is commonly not used by displaced persons.

Ranse J. (2011). Disasters happen: Practice implications and issues; Key Note Speaker for the 4th Passionate about Practice Conference, Brisbane, Queensland, 8th August.


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