The area of disaster health has come a long way since Australia’s first major international response to the tsunami that wiped out the western coastal areas of Aceh in 2004. While still in its infancy, there is a growing number of health professionals dedicated to the field and researching how nurses can assist when a disaster strikes, writes Karen Keast.

Jamie Ranse always felt quite at home working in emergency nursing.

Most of his nursing experience has been spent in the emergency department environment and also volunteering for St John Ambulance Australia, where he has volunteered for 25 years and has served as a company director for St John Ambulance ACT and held the high-level national strategic position of Chief Nurse.

During the Canberra bushfires in 2003, Jamie found himself setting up an evacuation centre where people could seek health advice and medical assistance.

“It was my first experience of assisting in a bushfire and in a disaster,” he says.

“The hospitals were quite overwhelmed and we were essentially cut off by the bushfires.

“It made me question how we do things - how well prepared is the community, what is the role of health professionals in those environments and what training should you need?”

It was an experience that sparked Jamie’s interest in disaster health, and where he has since assisted St John Ambulance in organising nurses and emergency health care for the 2009 Victorian bushfires and the Queensland floods.

Jamie is now an Assistant Professor at the University of Canberra, where he teaches in the undergraduate nursing program and conducts research into his specialty areas, in mass gathering health and disaster health, while maintaining his clinical skills as a casual nurse in the emergency department at Calvary Health Care.

The area of disaster health, while still in its infancy, is a field Jamie relishes.

“I really enjoy it because disaster health is an area that is quite evolving,” he says.

“It’s a step up from the emergency department. It’s like the emergency department of the emergency department - it’s the next step up with the excitement.”

Jamie is now undertaking a PhD through Flinders University, exploring the experience of Australian civilian nurses who participate in disasters, including the transferability of nurses’ experience between the in-hospital and out-of-hospital disaster environment.

He has also been involved in conducting research into the roles of nurses who assisted in the Black Saturday bushfires.

That research, involving interviews with volunteer nursing members of St John Ambulance Australia, found nurses were educationally prepared and had adequate clinical experience but nurses found themselves administering little clinical care and instead providing psychosocial support, coordinating care and resources while also acting as problem solvers.

“The research that we did from the bushfires from 2009 in Victoria found that the nurses didn’t really undertake much of a clinical role in the days following the bushfires but one of the largest activities they did was the psychosocial support of the community,” he says.

“A person might have had a cut finger but they were really there wanting to talk to somebody about the events that had occurred to them.”

The research found people involved in the disaster would rather talk to someone external to the event rather than unloading their experiences and fears onto people emotionally impacted by the disaster.

Jamie says this knowledge should be used to develop education programs, competencies and policies, while informing nurses about the realities of working in disaster environments.

“Nurses need to have some awareness and education about how to manage people from the psychosocial aspect,” he says.

“It’s really important to have mental health-specifically trained nurses as part of the teams that assist in the communities following a disaster.”

Jamie is chair of the newly formed Disaster Health Faculty at the Australian College of Nursing, which hopes to develop and implement new knowledge and practice for nurses and other health care professionals in disaster health.

“All nurses, regardless of whether they are in the hospital or community, have a role to play in disasters,” he says.

“I think it’s really important all nurses have some awareness of what it’s like to work in a disaster.

“What I mean by that is when a disaster happens sometimes hospitals will lose their power or their sewerage or water and it’s about how we continue to go about our daily activities and care for patients without the types of resources we normally rely on.”

Jamie says it’s also a field that stretches to ensuring Australia has workforce capability in a disaster.

“Would nurses turn up in a disaster or would they prefer to stay at home and care for their loved ones and protect their home?”

Jamie says research shows nurses who have had some education in the area would be more willing to work, particularly in bushfires or floods, but people are less willing to work in nuclear or vague respiratory-type illness events.

“Institutions should have in place some procedures and the right equipment, and that increases people’s willingness to go to work in those events,” he says.

“It’s not just nurses; it’s all of the health care professionals. It relies on everybody to come together, including the medical officers, the physiotherapists, people in pathology and radiology.

“It’s not just specifically for nurses. However, we know that in our hospitals, nurses are the largest workforce.”

Jamie says it’s not until a disaster unfolds that we tend to think about our response to disasters.

“I think it’s important that all nurses have a basic awareness of what a disaster is like and what their role might be in a disaster,” he says.

“It can be almost like you are camping in the middle of a disaster, when you don’t have the infrastructure and essentials such as sterile water.”

Jamie wants nurses to also understand their organisation’s approach to disasters - to locate their disaster manual or procedure, see when it was written and urge their hospital or health service to update it or provide education on disaster health.

“I think it goes back to disaster awareness,” he says.

“There are requirements for hospitals through the accreditation process to have some disaster preparedness; that could just mean they have a disaster plan in place.

“It doesn’t mean that their plan has been tested or that doctors or nurses know about that plan.

“I think it’s important that they collectively push health services to present them with some information about what it is like for them to work in a disaster, and what it’s like to work in a disaster from their health services’ perspective.

“Disasters do happen. When disasters happen nurses play an important role in supporting the community’s health needs,” he says.

“It’s really important for those in the immediate affected communities to have some awareness of what they do in a disaster.”