This article was written by Enid G. Harden, PAHO Nursing Adviser and Hilda Filinich de Zegarra and Gladys Zárate León, President and member, respectively, of the Scientific Commission of the Peruvian School of Nursing.
Nurses will be involved to one degree or another when a disaster occurs. At times, her or his role will be critical. To perform efficiently, the nurse must be prepared to change plans of action at any time and adapt to new situations, be a planner, health educator, care provider, administrator, intervene in crises and, sometimes, manage triage.
Nurses are often the only health team member working in the community. Their training for emergencies is crucial. Photo: J. Vizcarra/OPS
It is therefore necessary to prepare the nurse at undergraduate and graduate levels. We consider the minimum basic course requirements to be: first aid, cardiopulmonary resuscitation, psychological crises intervention, triage and protocols for nursing care.
In November 1982, the Peruvian School of Nursing and the Pan American Health Organization held a workshop on the "Role of Nursing in Emergency and Disaster Situations." The objective was to prepare nurses for a greater participation in the management of disasters such as earthquakes, floods, droughts and landslides which occur relatively frequently in Latin America. Throughout history these natural hazards have caused a great number of victims and social and economic consequences.
The following main conclusions and recommendations emerged from the work groups and plenary sessions:
1. That tire nursing departments of each health institution have an emergency nursing plan for disasters winch is compatible with the institutional plan and with Civil Defense plans for the health sector.
2. Given the importance of nursing in disaster situations, nurses should be represented on the multidisciplinary and multisectorial committees set up to develop general disaster plans.
3. The tasks of nurses In disasters and emergency situations are:
Planning: prepare action plans for nursing according to community risks; maintain up-to-date inventories of community resources; organize disaster simulation exercises, and elaborate emergency nursing protocols.
Administration: organize nursing teams according to area of responsibility; identify nursing staff and supply needs according to local conditions; coordinate nursing activities with the larger health team and other sectors, and set up logs and nursing reports for emergency and disaster situations.
Care: participate in triage; provide nursing care according to established protocols, and manage emotional crises of patients in coordination with other health team members.
Teaching: develop courses on disasters for nursing personnel and the community.
Research: participate in epidemiologic surveys after disasters and carry out operational research on the effects of disasters on the health of communities and ways in which to reduce the impact through nursing care.
4. Include a content area and case studies on disasters in course materials of nursing schools, in order to train nurses to carry out the above tasks.
5. Develop post-graduate courses of the same nature to enable nurses to take on even more complex tasks in times of emergency.
6. Elaborate nursing protocols that serve as guidelines for their functions in times of disaster or emergency. Six -preliminary protocols were already sawn up during the workshop, for care of burns, exposed fractures, uninfected open wounds, pyschological crises, asphyxia and hemmorhage.
Concern about nursing care in disasters is not limited to Peru. The National Social Security Institute of Ecuador has field three workshops on health sector preparedness for disasters which included hospital directors and administrators as well as nurses. In Barbados, a workshop similar to the Peruvian one was held to carefully analyze the role of nurses in disasters.
Note from the Editor:
Nurses are a vital part of the health team and often are its only representative in the community. Their training for emergencies and disasters is hence crucial. It is well worth considering the inclusion of such subjects as epidemiologic surveillance after disasters, national disaster plans, hospital planning for internal and external emergencies, management of nutrition and feeding programs, mass casualties, triage, and other related areas, in the regular training curriculum of schools of nursing. PAHO is willing to lend technical cooperation, as resources permit, to schools of nursing and other institutions that are interested in developing such a program.