How prepared are nurses and other health professionals to cope in and manage disaster situations?

It is mid-May and I am at my desk in Japan trying to keep to publishing deadlines, with my editorial due for the September issue. I really don't have to think too hard about what will be the focus of this editorial. Today, there are news headlines around the world about two recent disasters in South-East Asia. The first has struck in Burma, the second in China. On the first weekend in May, a widespread area of the Irawaddy Delta was ravaged by Cyclone Nagis, with winds of 180 km/h, inundating many provinces with drowning waters and sweeping away whole towns and villages. Up to 80% of the buildings were destroyed in some areas, leaving hundreds of thousands of people injured and homeless and an untold number dead (ABC News, 2008a). Today, some 2 weeks later, news headlines describe the frustration of foreign governments and aid agencies who have been unable to help Burma due to the lack of acceptance of foreign aid by the Burmese government. The United Nations has stepped in to try to convince the Burmese military rulers to allow a steady flow of cyclone aid into the country. A BBC reporter has described whole regions where no aid has reached survivors and bodies are still floating in the rivers 12 days after the disaster (ABC News, 2008b). The second disaster occurred in the Sichuan province of China. On 12 May, an earthquake of 7.9 magnitude struck and today's news indicates that some 20 000 people have been confirmed dead, with many more buried under devastated buildings. In Sichuan, disaster relief operations were quickly mobilized. As I write, ∼ 130 000 army and paramilitary troops are now assisting local authorities in the search-and-rescue effort in Sichuan, sifting through dozens of towns that have been turned to rubble (ABC News, 2008c). Although the responses to these humanitarian disasters in two developing countries have been quite different, the potential and actual human suffering in each case has been enormous. Doubtless, efforts at the sites of these disasters have been affected by the preparedness of health professionals and the poverty situations in those regions. I cannot help wondering: How prepared are nurses and other health professionals to cope in and manage disaster situations around the world? My 35+ years of international nursing and nursing education experience tell me that the vast majority of health professionals are not prepared at all in many countries of the world. Nurses, for example, are often only prepared in first aid measures in case of accident or in coping with casualty responses within the organized environment of hospital emergency departments. With the world becoming increasingly affected by global warming, and what seems to be a growing number of environmental disasters, nurses need to face the fact that disaster preparedness has become a global issue and they need to do something about it. At the International Council of Nurses (ICN) conference in Yokohama, Japan, last year the theme was “Nurses at the Forefront: Dealing with the Unexpected”. A significant focus was on nurses dealing with pandemics, epidemics, sudden crises, and disasters. Subsequently, the ICN has devoted part of its website to disaster preparedness (ICN, 2008). No doubt, some of the impetus for this has come from Dr Hiroko Minami, ICN President, who has mobilized Japanese nurses into preparing better for disasters through her efforts in helping to establish the Society of Disaster Nursing after the Hanshin and Awaji earthquakes of 1995 and a disaster nursing research center in Hyogo University in Japan. Medicine, it seems, has been preparing a little longer on the global front, for the 16th World Congress on Disaster and Emergency Medicine has just been held in Canada. Health disciplines need to mobilize greater efforts in being prepared to face the immediate and after-effects of disasters, so as to reduce morbidity and mortality and improve health outcomes. This includes not only staff education and skill preparation to treat physical injury, but also caring for the after-effects of post-traumatic stress, depression, and socioeconomic upheavals within communities (Jones, 2006). So, I challenge readers to look at the curriculum of various health programs they might be involved in to see just which content, if any, helps to prepare health leaders, managers, and clinical specialists in health settings to orchestrate responses to mass-casualty disasters. If the content or specific courses are not available, start writing and convincing others of the necessity. Training for the mobilization of effort in emergency situations needs to be planned and given to all health professionals, not just in building evacuations in case of fire in a hospital, but in large-scale disaster situations. This cannot be delayed anywhere in the globe, given that disasters are likely to become more frequent and much more severe (Patz & Khaliq, 2002). It behooves us all to start preparing now. In this issue, Professor David Arthur, Head of the Alice Lee Centre for Nursing Studies at the National University of Singapore, provides us with a timely and comprehensive editorial on nursing and nursing education in vibrant Singapore. This is part of our ongoing series of editorials on nursing and nursing education in various countries of the world. David is well known in Asia, having spent many years working as an academic in Hong Kong and Australia. He has significant experience in nursing education, research, and leadership and maintains strong contacts throughout Asia and elsewhere through the East-Asian Forum of Nursing Scholars and by being Editor-in-Chief of The Asian Journal of Nursing. I am sure you will be very interested in what he has to say, as well as find something to pique your attention in the quality articles in this issue from our other international authors.

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