Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting

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1 Collegia (2010) 17, available at Black Saturday ad the Victoria Bushfires of February 2009: A descriptive survey of urses who assisted i the pre-hospital settig Jamie Rase, RN FRCNA, BN, GCertCliEpi, GCertCliEd, MCritCarNurs a,b,c,, Shae Leso, RN FRCNA, BN, MPH, MSN(NursPrac) d, Brett Aimers, RN FRCNA, BN, GCertCritCarNurs, GCertCliEd a,c a Faculty of Health, Uiversity of Caberra, Australia b Fliders Uiversity Research Cetre for Disaster Resiliece ad Health, Australia c St Joh Ambulace, Australia d Royal College of Nursig, Australia Received 1 April 2010; received i revised form 2 August 2010; accepted 12 August 2010 KEYWORDS Nurse; Bushfire; Wildfire; Preparedess; Disaster; Educatio; Emergecy respose; Medical respose Summary Backgroud: I February 2009, bushfires devastated the state of Victoria, Australia, resultig i the loss of property ad life this evet was amed Black Saturday. Pre, durig ad post the impact of this evet, health care professioals, such as ursig members of St Joh Ambulace Australia, provided cliical care i the pre-hospital eviromet. There is a paucity of literature regardig the cliical ad disaster backgroud, educatio ad preparedess of those health care professioals who assist i similar emergecies, as such the characteristics of respoders are ot well uderstood. Method: This research used a retrospective descriptive postal survey desig, to survey ursig members of St Joh Ambulace Australia regardig their ursig experiece; pre-hospital experiece; disaster educatio, traiig ad experiece; ad their role durig the respose to the 2009 Victoria bushfires. Results: A total of 53 urses were approached for iclusio i this research, of which 24 (45%) volutarily participated. Males represeted 46% ad females represeted 54% of participats. Participats had more combied years of ursig experiece i the medical ad surgical eviromets, the other areas of practice. Post-graduate critical care ursig was the primary area of completed post-graduate educatio. The previous disaster experiece of participats was pricipally related to bushfire emergecy respose. Most participats had udertake disaster related educatio, however this varied i type ad duratio. Similarly, most had participated i traiig or mock disasters; however this was commoly ot related to bushfire emergecies. Correspodig author at: Uiversity of Caberra, Bruce, ACT 2601, Australia. address: jamie.rase@caberra.edu.au (J. Rase) /$ see frot matter 2010 Royal College of Nursig, Australia. Published by Elsevier Australia (a divisio of Reed Iteratioal Books Australia Pty Ltd). All rights reserved. doi: /j.coleg

2 154 J. Rase et al. Durig the respose to the Victoria bushfires, those urses who udertook a cliical role did so at a stagig area, carig for fire fighters ad workig with other members of their orgaisatio. Half of the participats udertook a admiistrative role. Coclusios: This research has provided isight ito the characteristics ad level of preparedess, of urses who respoded to the 2009 Victoria bushfires. Previously, such iformatio has ot bee available i the literature. I this research, males were overrepreseted whe compared to the atioal average of urses. The most amout of ursig experiece was i the medical ad surgical eviromet, this is cosistet with atioal ursig workforce treds. Whilst most had cliical experiece i bushfires, o traiig or mock scearios focused specifically to bushfires. There is a eed to explore further, the various roles udertake by urses durig respose, as this research has focused o oe evet the 2009 Victoria bushfires Royal College of Nursig, Australia. Published by Elsevier Australia (a divisio of Reed Iteratioal Books Australia Pty Ltd). All rights reserved. Itroductio Durig late Jauary ad early February 2009, the State of Victoria, Australia, was experiecig sustaied hot ad dry coditios ot see sice the Ash Wedesday bushfires of These coditios were fuellig umerous bushfires that had igited throughout the state. O February 7th 2009, Victoria experieced extreme weather coditios, with maximum temperatures ragig from 46.4 C (115.5 F) to 48.8 C (120 F) ad wid gusts i excess of 115 km/h (BOM, 2009). The weather coditios o this day, combied with the already existig fires, resulted i loss of 2000 properties, 61 busiesses, 173 lives ad cosiderable umbers of displaced ad effected persos (Victoria Govermet, 2009). Cosequetly, the state ad atioal burs disaster plas were activated. Durig this period, urses participated i the health respose to the bushfire emergecy, both withi the i-hospital ad out-of-hospital eviromet. The educatioal preparedess, required resources, backgroud ad experiece of urses who participated i the health respose, particularly i the out-of-hospital eviromet is ot well uderstood. Such iformatio may ehace future preparedess ad respose policy, guidelies or stadards. Further research i this area may assist i bridgig the existig kowledge gaps, highlightig the cliical ad educatio backgroud of respoders, their experiece ad scope of practice. This is the first origial research that aims to describe the cliical backgroud, disaster traiig ad educatio, ad roles urses udertook whe participatig i a health respose to evets such as bushfires. Throughout this mauscript the term urse refers to both Registered ad Erolled urses. Backgroud Aually, Australia commuities are threateed by bushfires ad the Australia health system has experieced the result of bushfires o umerous occasios. Durig the Victoria bushfires, over 400 patiets preseted to emergecy departmets across Victoria. Of these, 22 were referred to the state s burs referral cetres, which had capacity for additioal patiets (Camero et al., 2009). The published literature pertaiig to the health respose of bushfires suggests that the health system, whilst stretched i some circumstaces, has ever bee overwhelmed. The Caberra (Richardso & Kumar, 2004) ad ow Victoria bushfires (Camero et al., 2009) highlight that the health systems, ad predomiately emergecy departmets, maage sufficietly durig bushfire evets. This is due to factors such as, implatatio of exteral disaster plas, delayed ad staggered patiet arrival (Richardso & Kumar, 2004) ad most survivors sustaiig mior ijury (Camero et al., 2009). This experiece is similar to other evets, i which Australia hospitals have bee egaged durig health care emergecies, such as the Bali bombigs (Palmer et al., 2003). With icreasig umbers of deploymets of both civilia (Holia & Keith, 1998; Robertso, Dwyer, & Leclercq, 2005) ad military (Taylor, Emoso, & Schlimmer, 1998) urses to overseas disasters, it could be argued that disaster ursig is becomig a specialty. However, there is a paucity of published literature pertaiig to urses who atted disasters, their experiece, preparedess, role expectatios ad eeds to fulfil their role. Arbo et al. (2006) suggests that of those urses who voluteered for the Sumatra-Adama earthquake ad tsuami of 2004, may were uderprepared for iteratioal travel ad the majority had o prior disaster or military experiece. Such occurreces highlight the eed to improve educatioal opportuities for disaster urses (Arbo et al., 2006) ad the eed to idetify proactively the most appropriate health persoel to deploy. Nurses played a importat role i the respose to the Victoria bushfires. Nurses were deployed i teams with medical officers as part of the Victoria Medical Assistace Teams uder the State Health Emergecy Respose Pla to support hospital staff i rural ad regioal hospitals (Marti, 2009). It is suggested that urses who respoded as part of these teams had a cliical backgroud i emergecy ursig with specific educatioal preparatio i disaster maagemet. Additioally, urses were deployed i the out-of-hospital eviromet as voluteers with St Joh Ambulace Australia. St Joh Ambulace Australia cosists primarily of voluteers with varyig skills, kowledge ad experiece of mass gatherig ad emergecy health care. The orgaisatio has a well-established tiered cliical accreditatio framework, cosistig of first aiders ad first respoders, or laypersos, ad health care professioals such as paramedics, urses, medical officers ad allied health professioals. Nurses operate withi a atioal scope of practice utilisig their i-hospital or commuity-based competecies withi the pre-hospital eviromet (Rase, 2008). The orgaisatio has a well-established process for the deploymet of

3 Nursig who assisted i the Victoria Bushfires urses across jurisdictioal boarders durig health emergecies. These arragemets were put ito place durig the respose to the Victoria bushfires. St Joh Ambulace Australia sustaied a pre-hospital cliical role for a 7-week period; pre, durig ad post the bushfires. Durig this period St Joh Ambulace Australia voluteers assessed ad maaged close to 1200 patiets (persoal commuicatio with Mr Brett Aimers, State Professioal Officer, St Joh Ambulace Australia [Victoria], 12 Jauary 2010). To esure a efficiet ad effective future respose capacity of urses to assist durig bushfire emergecies, there is a eed to describe the cliical backgroud, educatio, traiig ad experiece of urses who assist durig emergecies ad disasters. This research provides a valuable step i uderstadig the urses preparedess ad experiece of participatig i a bushfire emergecy. Methodology Desig This research was retrospective i ature, utilisig a descriptive desig (Polit & Beck, 2008). Populatio ad sample The populatio for this research were ursig members of St Joh Ambulace Australia. The sample icluded participats from the populatio who had real life experiece of actively participatig i the respose ad/or recovery to the Victoria bushfires i Active participatio was defied as udertakig a role such as; cliical, coordiatio, support, commad or admiistratio. Participat recruitmet Potetial participats were idetified from duty rosters developed durig the bushfire emergecy. These potetial participat cotact details were the obtaied from the St Joh Ambulace Australia membership database. Potetial participats were posted a package cotaiig; a iformatio sheet about the research, the survey ad a replied paid evelope. Coset for this project was implied with the volutary ad aoymous retur of the survey. Data collectio Data was collected via a postal survey. The survey had six sectios with questios relatig to the participats: demographics, St Joh Ambulace Australia experiece, ursig backgroud, previous disaster educatio ad traiig, previous disaster experiece, ad Victoria bushfire experiece. For the purpose of this research, the defiitio of disaster has bee adopted from the World Associatio for Disaster ad Emergecy Medicie ad is described as a evet that iterrupts the ormal fuctioig of a commuity, resultig i the eed for exteral huma ad physical resources to assist i a respose beyod that of the ormal day-to-day operatig capacity for that commuity (TFQCDM/WADEM, 2002). Table 1 Participat demographics. Geder Male 11 (46%) Female 13 (54%) Age M = 34.5 SD = 13 (20 68) Data aalysis Data was etered ito STATA 10 for descriptive aalysis. Descriptive statistics, such as frequecy ad meas of cetral tedecy were used to summarise the participat resposes of the various sectios of the survey. Protectio of huma participats This research project was approved by the St Joh Ambulace Australia Huma Research Ethics Committee. The survey was volutary ad aoymous. Results Participat demographics A total of 55 Victoria ad iterstate urses assisted i the respose to the bushfires as members of St Joh Ambulace Australia. Two of the authors participated i this respose ad were excluded as participats of this research. Of the remaiig 53 urses, 24 (45%) respoded to this survey. Participat demographics are outlied i Table 1. Pre-hospital experiece I additio to a backgroud i ursig, oe of the participats had 10 years experiece as a paramedic. All participats had pre-hospital care experiece as members of St Joh Ambulace Australia. O average, participats had bee members of St Joh Ambulace Australia for 14.5 years [SD: 11, rage: 2 50]. Nursig characteristics Of the participats, 14 were registered urses ad 10 were erolled urses. The participats had a combied total of 302 years ursig experiece [M: 12.6, SD: 11.8, rage: 1 47]. The curret ad previous areas i which participats work ad the years of ursig experiece is outlied i Table 2. O average, participats work 50 h per fortight i a ursig capacity [SD: 23, rage: 8 80]. O average, participats had two ursig related qualificatios [rage: 1 5]. I additio to basic ursig qualificatios, such as a certificate IV, hospital certificate or bachelors degree, five participats had a ursig related post-graduate qualificatios. Some participats had multiple post-graduate qualificatios. The highest qualificatio attaied by participats ad areas of post-graduate qualificatios is outlied i Table 3.

4 156 J. Rase et al. Table 2 Work area ad years experiece. Table 4 Course type ad participatio. Participats Years Area of practice M SD Rage Medical Surgical Other Emergecy Primary care Aged care Mixed medical/surgical Metal health Midwifery Maagemet 1 14 Paramedic 1 10 Rehabilitatio 1 5 Perioperative 1 1 Itesive Care 1 1 Educatio ad traiig Of the 24 participats, 16 had previous disaster educatio. O average, these 16 urses had atteded two educatio courses [rage 1 4], havig a combied total of 324 h of educatio. The type of educatio ad the educatio duratio varied amogst participats (Table 4). Of the 24 participats, 17 had previously participated i a mock or simulated disaster traiig exercise. O average these 17 urses had participated i three mock disaster exercises [rage: 1 8] (Table 5). Experiece Sixtee participats had previous disaster experiece. O average, participats had bee ivolved i two disasters [rage: 2 5]. Of the 16 with disaster experiece, 13 had experiece i a bushfire emergecy, all participatig i a cliical capacity. Additioally, two of these urses had udertake a team leader role, ad a additioal two had Table 3 Highest qualificatio ad post-graduate qualificatio area. Qualificatios Qualificatio type Certificate IV 10 Geeral Certificate 4 Bachelor Degree 5 Graduate Certificate 2 Graduate Diploma 1 Masters 2 Post-graduate qualificatio area Critical Care 4 Midwifery 3 Metal Health 2 Advaced Nursig Practice 2 Trauma 1 Course Participat umbers Itroductio to Emergecy Maagemet MIMMS/ICS 5 76 Itroductio to 5 58 the Commader role Wildfire 6 20 awareess Chemical, 2 16 Biological ad Radiological Other 2 6 Total 324 Combied hours udertake a sector commader role. Of the remaiig three urses oe had disaster experiece as a member of a ambulace service (shootig), oe as a emergecy departmet urse (explosio) ad oe as a member of the state emergecy service (storm damage). Role durig Victoria bushfire Durig the Victoria bushfires, the 24 urses voluteered over 1560 combied hours [M: 65, SD: 54.5, rage: 8 190]. Durig this time, urses udertook roles across three distict domais: cliical, commad ad auxiliary fuctios (see Table 6). At varyig times, some urses, udertook multiple roles withi ad across these three domais. Of particular ote is that 17 udertook a cliical role ad half udertook a admiistrative role. Of the 17 urses who udertook a cliical role, they performed ursig duties i varyig settigs, cared for a diversity of populatios, ad worked with a variety other health care professioals (Table 7). At some poit, all worked at a stagig area, worked with other St Joh members ad cared for fire fighters. Table 5 Mock type Mock disaster type ad participatio. Airport disaster 15 No-specific multiple-casualty disaster 13 Rail disaster 3 Table-top exercise 3 Earthquake 2 Chemical, Biological ad Radiological 1 Boatig disaster 1 Shoppig cetre 1

5 Nursig who assisted i the Victoria Bushfires Table 6 Cliical, commad ad auxiliary roles udertake by urses durig the bushfires. Role type Cliical roles Cliical 17 Cliical Coordiatio 2 Triage 1 Cliical support 1 Commad roles Commuicatios 5 Icidet commader 4 Liaiso 2 Logistics 2 Area commad 2 Plaig 1 Auxiliary role Admiistratio 12 Data collectio 2 Peer-support 1 Discussio The followig discussio cotributes to our uderstadig of disasters health, particularly i relatio to the ursig characteristics ad preparedess of those who atteded the 2009 Victoria bushfires. This builds o existig Australia disaster health literature, which has previously outlied the characteristics ad preparedess of those who wated to voluteer, but did ot ecessarily atted a disaster (Arbo et al., 2006). Table 7 Performace characteristics udertake by urses durig the bushfires. Other characteristics Preformed duties at... Stagig area 17 Icidet commad cetre 5 Commuity cetre 3 Fire groud 2 Local hospital 2 Medical cetre 1 Cared for... Fire fighters 17 Geeral public 10 Displaced persos 7 Hospitalised patiets 1 Other 2 Worked with... Other St Joh members 17 Registered urses 7 Paramedics 6 Specialist medical officers 6 Erolled urses 4 Geeral practitioers 2 Other 1 Participat demographics I Australia, ursig remais a female domiated professio, with 9.6% of urses beig male (AIHW, 2009). This research illustrates that of those urses who assisted i the Victoria bushfires 46% were male. Whe compared to the proportio of male urses i Australia, males were over represeted i this group of urses who voluteered. This is a similar fidig to Arbo et al. (2006) who foud that of those urses who wated to voluteer for the Sumatra-Adama earthquake ad tsuami of 2004, males were overrepreseted. The reasoig for this overrepresetatio i disasters, of potetial ad actual ursig voluteers, should be explored i more detail as it may have implicatios for targetig preparedess activities ad policy developmet. Nursig characteristics The participats had a greater umber of combied years of ursig experiece withi the acute medical ad surgical ursig eviromet, whe compared to other areas. This is cosistet with the atioal proportio of urses who udertake cliical work (AIHW, 2009). Iterestigly more participats held post-graduate qualificatios i critical care areas tha ay other specialty ursig post-graduate qualificatios; oce agai this is proportioately similar to the atioal qualificatios (AIHW, 2009). Overall, it could be argued that the ursig characteristics of this sample were somewhat represetative of the ursig populatio i Australia. Educatio ad traiig Prior to the Victoria bushfires, the majority of urses had participated i some type of disaster educatio, however, the type ad duratio of this educatio varied betwee participats ad was o-stadardised. Similarly, the majority had udertake disaster traiig, primarily i the form of mock airport disasters or mock o-specific mass casualty icidets. However, o traiig was specifically related to bushfire emergecies. The high participatory rate i disaster educatio ad traiig i this research is similar to that of other research, such as seior emergecy departmet urses (Duog, 2009). However, these high participatio rates may ot be a accurate represetatio o the wider ursig commuity, as emergecy service orgaisatios ad emergecy departmets arguably have a more frot lie role, ad therefore iterest, i disaster educatio ad traiig. Core competecies for urses i emergecies ad disasters have bee suggested (Gebbie & Qureshi, 2002); however, these are ot ecessarily applicable to the Australia cotext. A eed exists to develop a structured approach to trai ad educate the most appropriate urses to the most appropriate level. Work has recetly commeced o a proposed disaster educatio ad traiig framework for the Australia cotext (FitzGerald et al., 2010). However, this is i its ifacy ad requires further developmet ad implemetatio.

6 158 J. Rase et al. Experiece Bushfire emergecies represeted the major disaster experiece for participats. This may highlight that bushfire emergecies costitute a large umber of emergecies i the Australia eviromet (EMA, 2010), which require a cliical respose beyod that of the ormal health capacity. Prior to the Victoria bushfires, some participats had udertake a leadership role durig a bushfire emergecy, such as a team leader or a commader. However, the majority of urses with previous disaster experiece had participated as cliicias i the bushfire eviromet. Victoria bushfire role Carig for fire fighters i stagig areas costituted the large proportio of the work for urses i the cliical pre-hospital respose to the Victoria bushfire emergecy. Additioally, may urses udertook team leader or supervisory roles. Nurses worked alogside voluteer lay members of St Joh Ambulace. They also worked with other urses ad specialist medical officers. Iterestigly, half of the urses had participated i some admiistrative tasks. It could be argued that there is little relevace ad value of usig urses to udertake admiistrative tasks, which could be completed by o-operatioal, o-cliical staff. Overall, i additio to udertakig direct patiet care, urses seemed to play a cliical guardiaship role. Coclusio This is the first origial research that described the cliical backgroud, disaster traiig ad educatio, ad roles urses udertook whe participatig i a health respose to evets such as bushfires, ad has provided isight ito the experiece of urses who participated i the prehospital respose to the 2009 Victoria bushfires. I this research, males were overrepreseted whe compared to the atioal average of urses. I cosistet with atioal ursig workforce treds, participats had more experiece i the medical ad surgical eviromet i compariso to other areas of ursig. Most participats had pre-hospital cliical experiece i bushfires respose, suggestig that the cliical respose to a bushfire emergecy i Australia is somewhat a regular occurrece. This research has highlighted that whilst urses traied for scearios such as airport disasters, i practice, these very rarely occur. Istead, urses were more likely to participate i a emergecy relatig to bushfires. Fially, there is a eed to explore the various roles udertake by urses durig respose to health care emergecies, particularly explorig the value of urses udertakig admiistrative roles. Limitatios The cliical backgroud ad experiece of urses i other orgaisatios may differ, as it could be argued that St Joh Ambulace Australia has a focus o evet ad emergecy health delivery. Similarly, the experiece of urses may differ durig differet health care emergecies. Ackowledgemets The authors would like to sicerely thak the participats of this research for their time. Additioally, the authors would like to thak the St Joh Ambulace Australia Huma Research Ethics Committee members for their time ad costructive feedback. Refereces Arbo, P., Bobrowski, C., Zeitz, K., Hooper, C., Williams, J., & Thitcheer, J. (2006). Australia urses voluteerig for the Sumatra-Adama earthquake ad tsuami of 2004: A review of experiece ad aalysis of data collected by the Tsuami Voluteer Hotlie. Australasia Emergecy Nursig Joural, 9(4), Australia Istitute of Health ad Welfare (AIHW). (2009). Nursig ad midwifery labour force I Natioal health labour force series umber 43. Caberra: AIHW. Bureau of Meteorology [BOM]. (2009). Bushfires i Victoria, 7 8 February Bureau of Meteorology, Australia Govermet olie: sevwx/fire/ / bushfire.shtml. Camero, P. A., Mitra, B., Fitzgerald, M., Scheikestel, C. D., Stripp, A., Batey, C., et al. (2009). Black Saturday: The immediate impact of the February 2009 bushfires i Victoria, Australia. MJA, 191(1), Duog, K. (2009). 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7 Nursig who assisted i the Victoria Bushfires Taylor, P. R. P., Emoso, D. L., & Schlimmer, J. E. (1998). Operatio Shaddock The Australia Defece Force respose to the tsuami disaster i Papua New Guiea. MJA, 169, TFQCDM/WADEM. (2002). Health Disaster Maagemet: Guidelies for Evaluatio ad Research i the Utstei Style. Glossary of terms. Prehospital Disaster Medicie, 17(Suppl. 3), Victoria Govermet. (2009). Victoria Bushfires Royal Commissio Iterim Report Australia: Victoria Govermet.