Disaster Response

Hurricanes. Tornadoes. Mass shootings. Global pandemics. Both human-made and natural disasters are catastrophic events that can overwhelm hospital systems by increasing medical needs and occupancy rates while decreasing the supply of resources. As the largest group of healthcare providers, nurses carry out vital roles in emergency situations: They act as first responders, triage officers, care providers, care and services coordinators, information or education providers, and even counselors. Whether nurses choose to work in disaster response or not, they will likely see themselves in this position at some point in their careers.

Although crucial when disasters strike, nurses must be adequately prepared to respond to crises to ensure the best possible outcomes. Read on to learn about the exciting and invaluable field of disaster response nursing and discover how you can prepare today!

Table of Contents

What Does Disaster Response Mean in Medical Terms?

Human-made and natural disasters can significantly increase the number of patients hospitals must serve, overwhelming hospitals with additional patients requiring immediate care and putting a strain on resources and staffing.

When disasters place large numbers of people at risk, aid and volunteer responder organizations travel to those locations to provide support. These organizations, such as the American Red Cross, largely depend on volunteer health professionals to provide on-site or on-call assistance. The healthcare that nurses provide in these settings is referred to as disaster response nursing.

Disaster or crisis response nursing is drastically different from regular nursing work. Volunteer nurses may help set up shelters to prevent and control infections. In this makeshift setting, they provide primary care services, administer medications, and monitor patients. Disaster nurses may also deliver supplies and equipment to impacted hospitals and help treat patients, in some cases relieving exhausted local staff nurses. Furthermore, depending on their credentials, disaster nurses can also offer mental health services to affected individuals and families.

Many nurses choose to volunteer, whereas some states, such as Florida, require licensed nurses to serve as first responders during emergencies. Regardless of state laws, the American Nurses Association (ANA) encourages nurses to join a volunteer registry, become familiar with their employers’ disaster response plans, and prepare individually for emergencies as well.

What Does EMS Stand For?

flood disaster

The abbreviation EMS stands for emergency medical services or emergency medical system. This term is one of many abbreviations used in disaster response. The following are other common disaster response abbreviations:

  • CERT: Community Emergency Response Team
  • FEMA: Federal Emergency Management Agency
  • HPP: Hospital Preparedness Program
  • DART: Disaster Assistance Response Team
  • DMAT: Disaster Medical Assistance Teams
  • EOP: Emergency Operations Plan

What Is a Disaster Response Unit in a Hospital?

Depending on the scale of human-made or natural disasters, hospitals may simply respond to crises through the staff and resources of their emergency departments. Nonetheless, all hospitals must have Emergency Operations Plans (EOP). These plans help hospitals recover from disasters by providing the necessary structure and processes. EOPs describe how hospitals should respond to hazards, including management of communications, resources and assets, safety and security, staff responsibilities, utilities, and clinical support activities.

Care standards are important aspects of EOPs. Care standards escalate from conventional to contingency to crisis standards.

  • Conventional care: Hospitals provide conventional care during stable phases when hospitals have sufficient space, staff, and supplies.
  • Contingency care: Hospitals transition to contingency care when they experience increased hospitalizations and demands on staff.
  • Crisis care: Hospitals enter the crisis care stage when the demands on space, staff, and supplies greatly exceed the available resources. Therefore, hospitals must ration supplies and modify their standards of care. At these times, hospitals may request government intervention and coordinate with other healthcare providers.

As crises subside and more resources become available, hospitals should transition back to contingency and conventional care.

What Is the Role of a Disaster Response Nurse?

tornado disaster

Nurses may carry out different disaster preparedness and response roles, each with its own set of responsibilities:

  • Working within their hospital or other facilities: Nurses can become familiarized with their facilities’ disaster preparedness and response plans, operational protocols, and security measures.  
  • Providing education: Nurses can educate patients and family members regarding safety during disasters.
  • Volunteering: The best way to prepare for disaster nursing is by becoming involved with an organized disaster response system. Nurses should consider volunteering with the American Red Cross, the Federal Emergency Management Agency (FEMA), or the United States Public Health Service (PHS).
  • Assisting during a disaster: During disasters, nurses may assess victims, deliver first aid and medication, and monitor mental health needs.
  • Preparing themselves and their families: All families should have emergency plans in case of disasters. This plan should include basic emergency supplies, a meeting place, communication, and access to essential paperwork. Having a family emergency plan in place can also give nurses peace of mind if they must work or if they choose to volunteer during a disaster.

What Does a Disaster Response Nurse Do?

According to the International Council of Nurses (ICN), all nurses should have the following core competencies in disaster nursing, allowing them to carry out necessary duties in disaster situations. These disaster nursing competencies can be grouped into the following eight domains:

1. Preparation and Planning

  • Maintain a personal, family, and professional preparedness plan
  • Participate with other disciplines in drills/exercises in the workplace
  • Maintain up-to-date knowledge of available emergency resources, plans, policies, and procedures
  • Describe approaches to accommodate vulnerable populations during emergencies or disaster responses

2. Communication

  • Use disaster terminology correctly in communication with all responders and receivers
  • Communicate disaster-related priority information promptly to designated individuals
  • Demonstrate basic crisis communication skills during emergency/disaster events
  • Use available multi-lingual resources to provide clear communication with disaster-effected populations
  • Adapt documentation of essential assessment and intervention information to the resources and scale of emergencies

3. Incident Management

  • Describe the national structure for response to emergencies or disasters
  • Use the specific disaster plan, including chain of command for their place of education or employment in an event, exercise, or drill
  • Contribute observations and experiences to post-event evaluation
  • Maintain professional practice within their licensed scope of practice when assigned to an inter-professional team or an unfamiliar location

4. Safety and Security

  • Maintain safety for self and others throughout disaster/emergency events in both usual or austere environments
  • Adapt basic infection control practices to the available resources
  • Apply regular assessment of self and colleagues during disaster events to identify needs for physical or psychological support
  • Use personal protective equipment (PPE) as directed through the chain of command in disaster/emergency events
  • Report possible risks to personal or others’ safety and security

5. Assessment

  • Report symptoms or events that might indicate the onset of emergencies in assigned patients/families/communities
  • Perform rapid physical and mental health assessments of each assigned patient or group based on principles of triage and type of emergency event
  • Maintain ongoing assessments of assigned patient/family/community for needed changes in care in response to the evolving disaster events

6. Intervention

  • Implement basic first aid as needed by individuals in their immediate vicinity
  • Isolate individuals/families/clusters at risk of spreading infectious conditions to others
  • Participate in contamination assessment or decontamination of individuals when directed through the chain of command
  • Engage patients, their family members, or assigned volunteers within their abilities to extend resources during events
  • Provide patient care based on priority needs and available resources
  • Participate in surge capacity activities as assigned, such as mass immunizations
  • Adhere to protocols for the respectful management of large numbers of deceased

7. Recovery

  • Assist an organization in maintaining or resuming functioning during and after disaster events
  • Assist assigned patients/families/communities to maintain or resume functioning during and after disaster events
  • Make referrals for ongoing physical and mental health needs as patients are discharged from care
  • Participate in transition de-briefing to identify personal needs for continued assistance

8. Law and Ethics

  • Practice within the applicable nursing and emergency-specific laws, policies, and procedures
  • Apply the institutional or national disaster ethical framework in the care of individuals/families/communities
  • Demonstrate understanding of ethical practice during disaster response that is based on utilitarian principles

“…we are not usually providing acute medical care. Red Cross disaster nurses are not first responders. We do some first aid, and staff disaster shelters, and assist victims with their longer term medical needs. But we are not climbing around in the rubble doing reverse triage (unless something very unexpected has happened)…(It’s) Intensely (rewarding). I would do disaster nursing full time if I thought I could make a living at it.” Redditu/auraseer

How to Become a Disaster Response Nurse

hurricane

Nurses interested in disaster response nursing should consider volunteering for organizations such as the following:

  • American Red Cross: This nonprofit organization assists over 70,000 people annually by providing food, shelter, and physical and mental health. Nurses can contact local chapters to affiliate and receive training. Then, during disasters, nurses, including licensed practical nurses (LPNs), registered nurses (RNs), and advanced practice registered nurses (APRNs), can use their professional skills to care for and educate shelter residents. Nurses volunteering locally are asked to commit to multiple shifts of four to twelve hours each. Nurses able to travel to other areas are asked to commit to at least ten to fourteen consecutive days working eight or twelve-hour shifts. In these cases, the organization covers travel, lodging, and meals.
  • Community Emergency Response Team (CERT): This program by the Federal Emergency Management Agency (FEMA) offers nationwide training and organization that professional responders can use in disaster situations. Interested nurses can search for a program, register their groups, and stay connected in their neighborhoods. Materials are free and are also shipped at no cost.
  • Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP): This federal program assists states and territories in establishing standardized volunteer registration programs for public health and medical crises and other disasters. The program verifies health professionals’ identification and credentials in advance, saving valuable time in emergency situations. All licensed and credentialed health professionals can register with the ESAR-VHP, including LPNs, RNs, and APRNs.

Disaster Response Nurse Certification

The American Nurses Credentialing Center is retiring the National Healthcare Disaster Certification (NHDP-BC™) on December 31, 2022. Nevertheless, certified clinicians who already hold the NHDP-BC credential can renew their certifications through professional development activities.

How Long Does It Take to Become a Disaster Response Nurse?

Anyone can volunteer in emergency situations, including nursing students. However, to work or volunteer as disaster response nurses, individuals must complete nursing programs to become LPNs, RNs, or APRNs.

Aspiring nurses can complete an LPN program in as little as a year. Additionally, those interested in becoming RNs have many options:

  • Obtaining an associate’s degree takes approximately two years.
  • Completing a bachelor’s of science in nursing (BSN) takes approximately four years.
  • Additionally, individuals with bachelor’s degrees in other fields can complete accelerated programs to obtain BSNs in one or two years.

Finally, aspiring nurses who wish to become APRNs must obtain a master’s or doctoral degree after becoming licensed RNs, which takes an additional one and a half to three years.

Disaster Response Nurse Salary

disaster

Many disaster response nurses don’t earn any salary at all for this role since they volunteer for nonprofit organizations, such as the American Red Cross. As volunteers, nurses can only expect organizations to cover travel, food, and accommodation expenses.

However, any nurse can find themselves in this role when disasters affect their area and the facilities where they work. For example, during the COVID-19 pandemic, all healthcare providers became disaster response professionals. In this case, nurses’ salaries depend mostly on their level of education. The following are average nurse salaries according to the US Bureau of Labor Statistics:

  • LPNs earn, on average, $50,090 annually or $24.08 hourly.
  • RNs earn $82,750 per year or $39.78 per hour.
  • Nurse Practitioners (NPs) earn $118,040 annually or $56.75 per hour.

An excellent option for nurses who wish to volunteer but also need a source of income is to work per diem. Since the definition of “per diem” is “per day,” working per diem gives nurses the chance to work as much or as little as they like and have the job flexibility to take time off to volunteer during times of crisis. Furthermore, nurses can significantly increase their hourly rate by picking up per diem nursing shifts, enabling them to take time off to volunteer.

What Is Disaster Response Nursing Like?

The best way to know what disaster nursing is like is by learning from the personal accounts of other nurses. Here are some testimonials of nurses who have provided disaster response nursing—whether they wanted to or not:

“I live in New Jersey and worked through Sandy. We weren’t hit as bad as some of the places near the shore but the hospital did lose all power for about two days with the back up generators really not doing much either…Since I work the night shift, it was literally pitch black. We had one battery operated lantern for the whole floor which really made you feel like Florence Nightingale while walking into your patients rooms…Most staff stayed overnight since roads weren’t drivable with the weather and trees down everywhere…By the next day, we received bus loads of patients from 3 neighboring hospitals that had been flooded. It was chaos…” Redditu/thegalactica

“Volunteered after the Haiti Earthquake 2010. It was very tough to see all the rubble and temporary housing tents. Worked daily 12 hour shifts in the med/surg tent hospital as the charge nurse and also taking 10 or more patients myself…There were no pharmacists to calculate IV drips for us or dispense meds. We had to get all the meds ourselves and the meds were just categorized in bins…Scariest thing I did there was calculating a Fentanyl drip for a child (I’ve never worked peds)…In the end, it was the most rewarding weeks of my life.” Redditu/kimster419

Is Disaster Response Nursing Hard?

fire

Human-made and natural disasters are difficult for everyone—certainly including the healthcare professionals who work during these crises. Suppose a disaster occurs in a nurse’s hometown. In that case, they will not only be responding to the disaster at work, but they may also be dealing with personal crises, such as damaged property or injured family members. In some cases, such as with the COVID-19 pandemic, nurses risk becoming infected while at work and even taking the virus back home. Furthermore, society expects nurses to be heroes, which puts added pressure on already overworked and possibly burned-out frontline workers. People often demand their rights to receive care but ignore that nurses have the same rights. Finally, nurses often need to continue working in compromised facilities with increased patient loads and insufficient staff.  

For healthcare professionals who choose to work in disaster response, there are some additional challenges:

  • Disaster response nurses are often volunteers who must maintain regular jobs in addition to their volunteer work. According to an American Red Cross volunteer, “It is tricky to do while holding down a regular job. Deployments are for a minimum of two weeks, and if activated you must depart within 24 hours.”
  • Disaster response volunteering often requires trainings and immunizations.
  • Nurses often have to work with limited resources and supplies.
  • Nurses might have to work in uncontrolled physical environments.
  • Healthcare workers often face threats, such as violence or infectious disease.
  • Clinicians might find themselves in situations in which they are required to practice outside of their professional scope of practice.
  • Nurses might also face life-and-death situations and difficult ethical decisions.  

What Makes a Good Disaster Response Nurse: Tips for New Nurses

An experienced disaster response nurse shared their experiences on Reddit. Here are some basic requirements for working as a disaster response nurse overseas:

“Your License (compact is best but they can make it work) CPR card and any additional certs. Passport, and immunizations. Generally any deployments to Africa or SE Asia require Yellow Fever and Typhoid, Cholera vaccine and Rabies are always good to have, Malaria meds if needed.”

Furthermore, here are some tips to help aspiring disaster response nurses put their best foot forward:

“Be respectful to your teammates and the locals. I’ve seen folks pulled from deployments for thinking they’re the best thing since Betty White. We all came to help, not one up each other…if you can’t sleep in a tent, around other people, or potentially carry your own luggage/other equipment for awhile it may not work out for you. Again being flexible is key, situations change by the hour, and you can’t get frustrated if plans change or missions get scrubbed.”

Final Thoughts on Disaster Response Nursing

Would you like to become a disaster response nurse, or are you wondering why anyone would choose this nursing specialty? Ultimately, the path you choose must be the right one for you, one that aligns with your strengths, personality traits, and values.
If disaster nursing doesn’t seem to fit, continue exploring other nursing specialties. The perfect specialty for you is out there, so don’t give up until you find it!

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