Recently I had the opportunity to provide nursing services after an earthquake disaster in the Caribbean. In this article, I share my insights gained from that trip, service opportunities, and considerations for whether or not disaster relief nursing is an appropriate choice for you. I also provide practical information for those who anticipate relief service.

Disasters then and now

In times past it took days, weeks, or even months to disseminate the news of disasters. For example, after major disasters in the United States like the Johnstown, Pennsylvania flood in 1889, the Galveston, Texas Hurricane of 1900 and the great San Francisco, California earthquake of 1912, it took weeks, even months, for the news to reach the victims’ families.

Mass media advancements of the twentieth century changed all of that. Now when disasters occur, members of the news media are able to almost instantly reach the disaster site and can broadcast coverage of the disaster right after it happens into our homes 24 hours a day, 7 days a week. We are bombarded with images of damaged structures and seriously injured and dead victims. It is almost impossible to dismiss the images of those injured or killed.

Immediate news coverage allows for prompt notification and mobilization of aid workers. Victims of the disaster have the opportunity to receive assistance much more quickly. The broadcast images of the disaster often stir emotions in the observer and motivate people to help in some way. There are indirect ways to help after a disaster including: donating money, donating goods, or donating time for activities such as telethons. Direct ways to assist include going to the site of the disaster to perform volunteer services. Disaster site aid volunteers come from a variety of types of organizations and perform a wide variety of services, including nursing services.

Disaster relief considerations

Many nurses who have provided disaster relief nursing care describe the experience as “exhausting”, “draining”‚ “overwhelming” but in the end, “very rewarding”. Others have said that they felt “proud to be a nurse‚” and felt good to be able to help their fellow man and woman in their time of need. They identified the ability to provide care, comfort, and pain relief as key components of their care. Still others have described the relief work experience as the “most significant contribution‚” that they have made in their nursing careers. Hearing about a fellow nurse‚Äôs experience has spurred colleagues on to say, “That sounds really interesting. Maybe I should sign up to go there.”

That having been said, on-site disaster medical relief service is not an appropriate way for everyone to help. There are as many reasons not to go as there are to go to the disaster area. There are several things to consider before packing a bag to go to help at a disaster. For the purposes of this article they will be divided into the following categories: physical, financial, psychological and practical.

Physical considerations

There are several physical factors to consider. First and foremost, are you healthy enough to survive the experience and be of help to others? If you become ill, you are not able to help anyone and when someone takes care of you, resources are taken away from disaster victims. Do you have the stamina to work long days? Relief work can be physically exhausting.

Are you able to sleep on an uncomfortable bed, often an army cot in a large area with strangers? Can you function with disrupted or limited quantity of sleep? Can you be on your feet for 12 or more hours? Can your back withstand bending over army cots all day to provide care?

Often, the water supply in a disaster area is non-potable making bottled water necessary. Volunteers must also face hygiene “challenges”because of lack of running water and flush toilets.

Relief work in heat and high humidity conditions can cause a volunteer to experience dehydration and electrolyte, particularly sodium and potassium, depletion. Meals are not always scheduled and food is not normally plentiful in a disaster area. Volunteers may have to rely on the non-perishable food items brought from home.

Some disaster areas are hot, humid and dusty with the threat of insect-borne diseases. Other areas are cold and damp with the threat of hypothermia and frostbite.

Populations in some disaster areas experience endemic diseases such as TB, malaria and AIDS long before the disaster.

Financial considerations

Volunteer work is not without cost to the volunteer. Many employers do not pay you your regular salary while you are away to provide relief services. It is therefore likely that you will fund your absence from work with paid time off or unpaid leave of absence.

The travel costs associated with getting to the point of embarkation for the relief group is often the responsibility of the volunteer, not the relief agency. Volunteers need to have a current passport and may need to apply for a visa to travel to the country.

The volunteer bears the cost of any immunizations that provide protection from diseases present in the disaster area. Costs associated with becoming ill in or as a result of having been in the disaster area are borne by the volunteer.

Psychological considerations

It’s difficult for volunteers to work away from their familiar surroundings, their family, and even their pets. Often it is not possible to contact family during the service period. Nurses may work with unfamiliar people because volunteers may come from other states or countries and have not met one another before the relief assignment.

Volunteers may experience feelings of being overwhelmed after seeing situations of extreme human suffering and personal loss. Some express the desire to “fix” everything that is wrong and become frustrated that they aren’t able to do more for the victims and their families. However, in disaster nursing, the main focus of care is to stabilize the patient’s condition.

Some volunteers have stated feelings of guilt when they take personal time like a break or have to leave the care area, thinking that they should do more.

Practical considerations

First and foremost, the potential volunteer should honestly answer the question, “Do I have something specific to offer this situation?”

Volunteer relief work can be challenging. The volunteer is working in a stressful situation away from their home and work support systems. Utilities are often disrupted in a disaster zone and communication with people at home may not be possible. Personal safety may be a concern in some disaster areas. Volunteer nurses often work in less than optimal environments with limited equipment available. Additionally, some volunteer staff may arrive and others depart on different schedules causing challenges to the continuity of patient care. Policies and procedures and job descriptions are often absent at disaster scenes.

A volunteer nurse must be mature and clinically experienced and able quickly to “think on her or his feet” to respond appropriately in a variety of challenging clinical situations. Care in disaster areas can be hampered by language barriers and cultural differences between nurses, other staff, and patients. Disasters usually disrupt transportation services to, from, and within the affected area. Travel to and from disaster areas is often limited to military and relief agency aircraft and overland vehicles. If the volunteer wants or needs to depart earlier than originally scheduled, transportation may not be readily available.

Preparation

Are you still thinking of going to a site to provide relief services? Then you need to get ready. Nurses are advised to try to travel to a disaster site along with a relief group, rather than going to the site independently. Relief opportunities are often listed on the Internet. Once a suitable group is identified, the travel dates need to be set. Your travel to the relief group’s departure city will need to be arranged, usually at your expense.

You will need proper documentation to travel to the site. For US destinations this will include your driver’s license and your professional license(s) with extra copies of each. Provide an emergency contact number to the group leader. For foreign destinations also include your passport and if necessary, a visa to enter the country with extra copies of each. Information about visa requirements for international travel is found on the United States State Department website: www.travel.state.gov/travel.

Research the health aspects of the disaster location. What diseases are prevalent there? What immunizations or other precautions are recommended for relief volunteers? At a minimum, current tetanus and hepatitis protection are usually recommended. Additional immunizations for specific diseases may be recommended, for example, typhoid and yellow fever. Anti-malarial medication is recommended for those traveling to a country where malaria is present. This kind of health information is easily obtained from the Centers for Disease Control (CDC) website: www.cdc.gov/travel.

Suitcases aren’t very practical in relief areas; consider using an expandable backpack. Leave your valuables at home since they are difficult to secure in a disaster setting. The gear that you should take includes your stethoscope and bandage scissors. You will usually need to take your own linens and bedding including sleeping bag, sheets, pillow and towel. For mosquito-infested locations add a mosquito net to sleep under and insect repellant.

Take your own toiletries, hand sanitizing gel, and wet wipes because water may not be available for bathing. For work in sunny locations, bring sun block. Avoid packing your curling iron and expensive makeup collection, since they will not be needed. Take your medications and a copy of prescriptions. If you wear glasses, bring an extra pair in case of loss or breakage. Contact lenses are not recommended for work in dusty locations or where bodily fluid may splash into the eyes.

Include basic first aid supplies such as tweezers, adhesive bandages, and antibiotic ointment. Practical items such as a flashlight and extra batteries are useful. Take nonperishable food items such as nutrition bars, nuts, peanut butter and crackers, and lunch kits. Ask if bottled water will be supplied. You may need to bring a case of bottled water for your use. For hot climates, also take electrolyte replacement beverages (sports drinks) or packets of electrolyte powder to add to water.

Research the weather at the relief site. If it is hot and sunny, bring lightweight natural fiber clothing like cotton t-shirts and cotton pants or scrub outfits, a bandana for moisture absorption, a hat for sun protection, and sunglasses. For relief assignments in cold climates, consider taking a hat, scarf, clothing that can be layered, heavy socks, and possibly boots. Relief workers’ feet may be exposed to a variety of chemicals and/or bodily fluids or structural debris. For any relief assignment, be sure to take sturdy leather or man-made material, thick soled, closed toed shoes or hiking boots that are comfortable, can protect the feet, and can be cleaned off with a wet cloth. Last and most important, it is essential to bring along an open mind, flexibility, patience, and a sense of humor. These are survival skills that can often make even the most challenging of situations bearable.

Susan Stelton is a medical-surgical clinical nurse specialist at Banner Good Samaritan Medical Center in Phoenix, Arizona.

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References

Centers for Disease Control. Guidance for relief workers and others traveling to Haiti for earthquake response. CDC. Atlanta, GA. March 2010.

U.S. Department of Health and Human Services. A guide to managing stress in crisis response professions. DHHS Pub. No. SMA 4113. Rockville Maryland. 2005.