The Role of Nurses in Disaster Response

How Nurses Prepare and What They Do During Disasters

Whether they’re caused by nature, negligence, or malice, large-scale disasters wreak havoc on millions of people’s lives. Families are often displaced from their homes and belongings, and local businesses and infrastructure can be damaged beyond repair. Worst of all, many disasters cause widespread injuries and loss of life.

In any disaster scenario, treating the sick and injured is an obvious immediate priority. It also gets much more challenging when local healthcare facilities become overwhelmed. And while nurses are essential in even the calmest of times, they’re even more critical in emergency situations when resources are limited and healthcare systems are strained.

Nurses are the frontline healthcare providers in many disaster response efforts. Their actions and decisions—and the support they receive—can have major implications for the disaster victims they treat.

What’s the Definition of a Disaster?

Most health and emergency-aid organizations define a situation as a disaster when an appropriate response requires far more resources than the local community can provide. Naturally, that includes a community’s ability to treat any resulting injuries or illnesses.

Disasters can occur naturally—like earthquakes, hurricanes, tsunamis, or landslides. They may also be caused by pandemics, chemical or environmental contamination, or by acts of war or terrorism. Disasters are as unpredictable as they are destructive, and a swift response can make a serious difference in saving lives and minimizing damage.

According to the National Library of Medicine (NIH):

“In the past decade, 2.6 billion people around the world have been affected by earthquakes, floods, hurricanes, and other natural disasters. Nurses have been and continue to be pivotal in safeguarding the public during and after these disasters, as well as public health emergencies—most recently, the COVID-19 pandemic. They educate and protect people, engage with and build trust with the community, help people prepare and respond, and foster resilience to help communities fully recover.”

Nurses’ Preparedness for Disaster Response

Adequate training is paramount in preparing nurses to deal with all kinds of disasters. While nurses are used to thinking and acting quickly at work, things become more complicated when clinical facilities are inundated with patients, or when nurses are forced to deliver care in less-than-ideal circumstances.

From their first few courses in nursing school, nurses are trained to stay cool in unpredictable situations—including disasters. Some schools offer entire courses focused on disaster nursing. Others use modern training tools like virtual simulation labs to recreate disaster scenarios and other rare events, so nurses know how to respond when they experience the real thing.

Nurses interested in additional disaster relief training can find learning opportunities through multiple organizations. The Federal Emergency Response Agency (FEMA) offers a number of courses through their Emergency Management Institute, including several free self-paced courses on emergency planning, management, and response. The American Red Cross also offers disaster preparedness courses, with some specifically designed for nurses and nursing students.

In addition to these optional courses and certifications, most hospitals and healthcare facilities will have their own disaster preparedness training policies. Whenever a catastrophic event happens, there must be a plan in place to account for both current and incoming patients, and to prioritize limited space, resources, and supplies.

The Big Three

According to NursingEducation.org, there are three primary elements that nurses must focus on to prepare for disasters: communication, resource assessment, and readiness exercises. In pre-disaster settings (or the planning stages), nurses usually act as liaisons between other healthcare professionals, emergency responders, and affected communities.

Nurses may need to explain potential health risks, encourage emergency preparedness, and collaborate with other sectors. Effective communication is crucial to success in any scenario, let alone a disaster or disaster preparation. In addition, nurses must assess and understand the resources that are available to them. Some of their tasks might include identifying necessary medical supplies, ensuring the adequacy of staff levels, and determining whether more resources are required. Nurses would likely need to acquire more resources for vulnerable populations as well (i.e., children, the elderly, and the disabled).

Lastly, nurses should participate in readiness exercises to prepare for potential disasters. These exercises might feature evacuation practices, emergency drills, and tabletop simulations. The goal of these efforts is to determine whether there are any gaps in a disaster response plan and improve the effectiveness of it.

Nurses’ Roles in Disaster Response

Nurses take on several crucial roles in disaster relief situations and post-disaster recovery efforts. When a disaster strikes, some nurses may be sent to established or alternative healthcare facilities within their community. Others will need to stay behind and continue caring for patients that are already hospitalized.

In the aftermath of a disaster, it’s common for nurses from other parts of the region or country to step in and help. Lots of nurses volunteer with disaster response organizations that deploy healthcare workers to affected areas both near and far. Some states even legally require licensed nurses to serve as first responders in emergencies.

Triage & Initial Care

When the demand for medical services is overwhelming the immediate available capacity, one of the most important tasks is performing triage. Triage is the process of sorting patients into different priority levels. The goal is to do the most good for the most people with a limited amount of resources.

In a disaster situation, patients with immediately life-threatening conditions need to be given priority over others with unpleasant (but not dire) injuries like broken bones. On the other hand, spending time and resources on a patient who is unlikely to survive can cause multiple other patients to die or develop lifelong disabilities.

Nurses working emergency triage provide initial assessments and treatment, and prioritize which patients need what type of care. The idea is to stabilize their condition, manage their pain, and give them the best chance at a positive long-term outcome.

Records & Documentation

Accurately recording each patient’s information is essential when people are receiving first aid at the site of a disaster before they’re transported elsewhere for additional care. Maintaining continuity of care becomes more challenging in disaster scenarios, so “triage tags” are commonly used to record important details about each patient and their condition.

In addition to keeping track of patients’ identities, medical conditions, and care instructions, accurate record-keeping helps emergency planners and policymakers gather important data that’s useful in future disaster preparedness efforts.

Mental Health First Aid

People who live through traumatic events like disasters can experience severe emotional and psychological distress. Another primary responsibility of nurses in disaster response efforts is providing mental health support to people in need.

Nurses are trained to recognize the signs of distress and offer psychological first aid to victims of large-scale disasters. Once a person is no longer in immediate crisis, nurses help connect patients and their families with longer-term resources for mental and emotional support.

Public Health Efforts

In disaster situations, nurses are also called upon to help with a variety of public health initiatives. This could mean dispensing vaccines at pop-up clinics during a pandemic or educating people on disease prevention when safe water or reliable plumbing are in short supply. It could also mean helping with decontamination efforts after large numbers of people are exposed to hazardous materials.

Challenges Faced by Nurses in Disaster Response

Short-Staffing and Long Hours

In the wake of a major disaster, nurses are often pushed to their limits. Long hours are common, whether volunteering with a disaster relief organization or working in a healthcare facility that sees a sudden, massive spike in patient volumes. Emergency care is also physically demanding due to its fast-paced environment.

Emotional Fatigue

Responding to disasters as a nurse can also be very emotionally fatiguing. Disaster nurses often treat people on the worst day of their lives and are sometimes exposed to more traumatic and gruesome injuries than usual. Seeing so much human suffering in one place can take a toll, so it’s important for nurses working in disaster response to maintain good self-care habits.

Limited Resources & Unconventional Environments

In disaster situations, nurses frequently administer care in non-traditional environments. People usually need immediate first aid at disaster sites, which are far from a sterile clinical environment. Beyond the triage phase, emergency response organizations sometimes take over open spaces like gyms or sports arenas to accommodate large numbers of people who need ongoing care.

While it’s second nature for most nurses to grab the materials they need in their usual clinical environments, providing patient care in an unfamiliar space is always a challenge. Medical supplies are often limited immediately following a disaster, which can force nurses to make difficult decisions about how best to utilize them.

Ethical Considerations

Working triage can also put nurses in challenging ethical situations. They may have to make the difficult choice to withhold life-saving care from severely injured people who will most likely die, even with medical help.

When the same number of staff or resources could save multiple other people from death or disability, nurses are obligated to act on behalf of the greater good. Different triage situations will have their own guidelines on how to prioritize care and resources, depending on how many people need immediate aid.

Cultural & Linguistic Barriers

Large-scale disasters transcend political differences and geographic borders.  Still, when nurses respond to catastrophes in other parts of the country—or on the other side of the world—there can be challenges with language barriers or cultural differences.

Some disaster-response efforts will have interpreters on-site to mitigate these differences. However, cultural competence becomes even more important for nurses working outside their home communities, which is part of why many modern nursing schools make it a priority throughout their curriculum.

Higher Risk of Infection

Evidence from past epidemics suggests that healthcare workers are at a much higher risk of infection than the public. During the SARS epidemic of the early 2000s, for example, healthcare workers accounted for one-fifth of infections globally. During the Ebola outbreak, healthcare workers were up to 32 times more likely to become infected than the general population.

In recent years, COVID-19 was difficult to contain because of its ability to spread by people who are asymptomatic. At the same time, COVID-19 had a reproduction rate of about 2.5 (the number of infections generated by each infected person), compared to the influenza virus rate of just 1.5. This means it spreads further and faster than the regular flu virus.

COVID-19 was also “novel,” or new. This means that, initially, no one had an immunity, so it spread faster among the population. In the U.S., the Centers for Disease Control (CDC) struggled to provide an adequate supply of COVID-19 test kits early on, which limited the ability of healthcare workers to identify who had the disease.

Success Stories of Nurses in Disaster Response

Throughout recent decades, nurses have responded to an enormous variety of disaster scenarios, some more well-known than others. While all these events were tragic and destructive, the efforts of local and volunteer nurses helped to save many lives and prevent further human suffering.

COVID-19 Pandemic

The COVID-19 pandemic is one of the most recent examples of nurses responding to public health disasters across the globe. In places with severe outbreaks, entire hospital departments were transformed into critical care facilities for COVID patients. Bedridden patients literally spilled out into the halls, and nurses took on superhuman levels of responsibility.

Nurses all over the world overcame supply, equipment, and staffing shortages to save many lives, despite significantly overloaded healthcare systems and often-brutal working conditions. Once vaccines became available, nurses also played an important role alongside other healthcare providers in distributing vaccines to the public. They also participated in outreach programs to educate people on the safety of vaccines and the importance of getting vaccinated.

The Role of Nurses During a Pandemic

A nurse’s role in a pandemic is dramatically expanded and increasingly critical. Nurses become the most important player in the screening, early diagnosis, and ongoing monitoring of infected patients. Nurses also assume the vital role of documenting a patient’s status and communicating it to other health officials.

Patients require nebulized medications and intubation, both of which increase the risk of airborne infection to the nurse. Because infection increases the patient’s risk of developing wounds, nurses must increase their vigilance for wound prevention.

To reduce the traffic in and out of rooms, nurses may be required to assume duties of other personnel, such as technologists and housekeeping. Finally, nurses will be needed to inform patients about the importance of regular flu vaccinations to reduce the demand for healthcare services during a pandemic.

In 2015, the American Organization of Nurse Executives (AONE) convened to discuss lessons learned from the Ebola virus disease and other emergencies. They identified skills and behaviors nurse leaders need to effectively manage a crisis. These include providing vision and influence to provide strategic decision making and guidance through all phases of a crisis.

Hurricane Katrina

Hurricane Katrina in 2005 was one of the most destructive natural disasters in U.S. history. Large sections of the Gulf Coast were severely damaged, and the vast majority of New Orleans was flooded for weeks on end due to fatal flaws in the city’s flood protection system.

Nurses from disaster-relief organizations and the armed forces provided triage care to hundreds of thousands of people who were displaced by the Category 5 hurricane, often in makeshift medical facilities with limited equipment and supplies.

The initial government response to Hurricane Katrina was widely criticized and eventually led to several policy changes to improve responses to future disasters. Still, many nurses and other volunteers put forth incredible efforts to care for the physical and psychological well-being of the people and families affected by Hurricane Katrina.

The Role of Nurses During a Hurricane

Like other disasters, it’s imperative that nurses maintain open communication lines during a hurricane. They must coordinate with local authorities and emergency management teams. Perhaps most importantly, nurses should remain calm and make quick decisions in high-stress environments. This means that teamwork is essential.

In addition to taking lives or causing serious injuries, hurricanes can also cause flooding, power outages, and transportation issues. As you might imagine, these disruptions cause significant problems when it comes to providing the public with medical care. Nurses might have to work without electricity, improvise if their supplies are low, and use manual methods to monitor patients. There is also a risk of water contamination, which would be very unsafe for both nurses and patients.

In some situations, nurses might have to relocate patients in flood-risk zones. This is often a complex and taxing process. Despite the chaos, it’s vital that nurses maintain accurate records and ensure continuity of care.

Learn more about the role of nurses in hurricane season here.

Haiti Earthquake

In 2010, one of the deadliest earthquakes in human history struck the Caribbean nation of Haiti, affecting over 3 million people. At least 100,000 lives were lost, and hundreds of thousands more were injured.

Despite logistical challenges due to a devastated transportation infrastructure, military personnel and disaster relief volunteers arrived from dozens of countries. Many nurses worked in field hospitals, often without electricity or reliable plumbing. Medical supplies became incredibly scarce during initial relief efforts, forcing nurses to improvise splints and other medical devices out of cardboard or anything else they could find.

The Haiti earthquake was a devastating tragedy with long-term effects that continue to the present day. But for the thousands of patients who received life-saving treatment in unthinkably challenging circumstances—and for their loved ones—the responding nurses made a massive difference.

The Role of Nurses During an Earthquake

During an earthquake, nurses play a pivotal role as they offer immediate medical aid. They must triage and stabilize patients while managing the rapid influx of people. Additionally, they monitor each person’s mental health and offer emotional support. Nurses may also coordinate transportation for patients who require advanced care.

Here’s a brief rundown of their responsibilities during an earthquake:

• Immediate Medical Aid: Medication, stabilization, and wound care.
• Triage and Prioritization: Assess and prioritize patients for treatment.
• Resource Management: Assist so that resources are allocated effectively.
• Mental Health Support: Offer emotional support and help others cope.
• Documentation and Record Keeping: Maintain accurate documentation.
• Coordination with Other Professionals: Ensure a comprehensive response.
• Long-Term Care: May engage in long-term support and care.

The Future of Disaster Preparedness and Response

Like many aspects of society, the future of disaster preparedness and disaster nursing will evolve out of necessity. Advancing medical and communication technologies will change how nurses treat disaster victims and collaborate with colleagues and volunteers, both in the field and in hospital environments.

The ongoing effects of climate change will also necessitate disaster preparedness efforts from federal and local governments. As certain areas of the world become increasingly affected by natural disasters like wildfires, floods, and tropical storms, coordinating response plans before disasters happen can be a major factor in minimizing property damage and physical harm.

Preparation and prevention efforts will also be important in response to evolving threats from biological or chemical weapons, or other disaster risks like pandemics, chemical spills, and anything else that could cause large numbers of injuries or illnesses.

Nurses who volunteer with disaster response organizations and seek out ongoing training will be ready to answer the call when a catastrophic event happens. It’s a good idea for nurses to stay engaged with nursing journals and other professional literature to keep up with advances in disaster nursing, triage best practices, and overall medical developments.

Prepare for Your Nursing Career Training at Provo College

Even in the face of major challenges, nurses’ contributions to disaster relief efforts have saved countless lives in response to disasters all over the world. Well-trained nurses who can manage emergency situations are one of the most important assets in minimizing suffering and helping disaster victims move on with their lives.

Providing critical care and support to people affected by disasters—or just everyday health emergencies—is a rewarding and exciting career for people with a strong urge to help others. The BSN program at Provo College can help you launch your nursing career training in as little as three years, thanks to a blend of flexible online courses and hands-on learning from experienced instructors.

Looking to learn more about a career in nursing? Check out our in-depth guide on how to become a registered nurse, and our list of the 20 highest-paid nursing jobs.