Equipping Nurses with Disaster Skills is Critical to Prepare for the Unpredictable

Equipping Nurses with Disaster Skills is Critical to Prepare for the Unpredictable

Disasters—both natural and man-made—can bring great loss and destruction, but are inevitable and unpredictable. Each year, we witness deadly earthquakes, hurricanes, floods, wildfires, accidents, and mass shootings.

Dating back to the Galveston Hurricane in 1900, Johnson & Johnson has demonstrated its unwavering commitment to disaster relief. Support continued during the San Francisco earthquake of 1906 through to recent disasters, like Hurricane Harvey and Hurricane Maria. Today, guided by  Our Credo, which states that the company must be “responsible to the communities in which we live and work and to the world community as well,” the company alongside our partner organizations continue to focus on responding and rebuilding in the wake of disasters across six continents. Our strong, longstanding partnerships give proof that banding together with others, uniting under a common purpose, sharing knowledge, and combining reach can bring results, as detailed every year in our Health for Humanity report. This report also highlights our Campaign for Nursing’s Future initiative.

At Johnson & Johnson, we recognize that nurses have a unique and critical responsibility when disaster strikes. They provide vital medical aid, comfort, and leadership during times of confusion, fear, loss, and suffering. Often, they face uncomfortable and dangerous conditions, with risk to themselves, limited resources, and very little sleep.

Although disasters usually follow a similar sequence of prevention, preparedness, response, and recovery, no two disasters are exactly the same. Nurses need different knowledge, a new set of skills, and diverse experience to respond to a hurricane, disease outbreak, or a transportation accident. As the backbone of disaster response, nurses must learn how to solve problems quickly, rapidly direct groups of people, prioritize needs, and allocate inadequate supplies.

Johnson & Johnson is helping to equip nurses with the skills to respond by partnering with organizations that train and mobilize disaster nurses. For example, Johnson & Johnson supports the TOMODACHI Disaster Nursing Training Program, which aims to deepen the professional knowledge of nursing students specializing in disaster medicine and nursing in Tohoku, Japan.

Born out of support for Japan’s recovery from the Great East Japan Earthquake and Tsunami in 2011, Johnson & Johnson is partnering with the U.S.-Japan Council to develop a seven-month Disaster Nursing Training Program. As part of the initiative’s cultural exchange, participants from Japan visit the U.S. to visit facilities specializing in disaster response and meet with U.S.-based experts who helped during and after 9/11 and Hurricane Sandy.

Many participants were personally impacted by the Great East Japan Earthquake—and became nurses as a result. Yumi Gima, a participant in 2018, said: “I experienced the Great East Japan Earthquake during my first year of middle school. At the time, there was no water in the area where I lived, and when I saw seniors volunteering to collect water, I became inspired to volunteer and help others. However, I could not take any real action at the time.

“I became interested in disaster nursing due to my experience during the earthquake—it is why I applied to this program. In recent years, a variety of disasters have taken place in Japan due to extreme weather. During the study tour in the U.S., I’ve learned about disaster response measures not only for earthquakes, but also for hurricanes and other disasters that cannot be easily studied in Japan. In the future, I would like to become a member of a disaster medical assistance team (DMAT) and be able to take positive action in times of disasters.”

In addition to developing disaster nursing skills, participants like Yumi share their memories of the Great East Japan Earthquake and Tsunami, while demonstrating their compassion for strangers. They interact with a multilingual and multiracial society, uncommon in Japan, and learn the importance of understanding and respecting other cultures, backgrounds, and ways of thinking to foster a global perspective not only as health providers, but also as human beings.

September is National Preparedness Month and programs like the TOMODACHI Disaster Nursing Training Program are critical for preparing frontline responders for the unpredictable. Johnson & Johnson appreciates that the need to care for, comfort, and advocate for patients comes naturally to nurses—even when their own health could be at risk. This compassion makes them vital during this time of unprecedented disasters and supporting their knowledge, skills, and abilities through training is imperative to help them mobilize and respond faster and, ultimately, save lives.

Personal Needs vs. Professional Responsibility: A Nurse’s Perspective During Hurricane Harvey

Personal Needs vs. Professional Responsibility: A Nurse’s Perspective During Hurricane Harvey

With hurricane season fast approaching, individuals in vulnerable areas are preparing for the possibility of an active hurricane season. Last year was a particularly active season that affected the Caribbean and most of the Gulf Coast areas. As health care providers, nurses are particularly affected due to our responsibilities to both our patients and families as well as ourselves. This can be not only physically stressful, but also emotionally taxing on the individual.

In August 2017, Hurricane Harvey hit the Texas/Louisiana coastal areas and caused massive flooding, damage, and fatalities. The Texas Medical Center in Houston sustained flooding that stranded many hospital staff and patients for several days while the hurricane lingered in the area.

Heidi Aghajani is a nurse employed in the Houston area who spent six days working at the hospital during Hurricane Harvey while also being responsible for her family at home. She shares her story and expresses how she was affected during our interview.

Heidi Aghajani

What do you think went well with the hurricane preparation efforts of the hospital?

The hospital constantly informed staff of the hurricane via text messages, emails, and even huddles with managers about what’s happening, what to expect, and the time frame of when to expect it.

When did that start?

It started probably about 4-5 days before we knew the hurricane would hit.

When did your hospital notify you that you would need to come in as the ride-out team?

They notified us that Saturday before the storm hit Houston.

For the preparation, how many days’ worth of clothes, food, etc. did they tell you all to bring?

We were told to bring 4 days’ worth of clothes and food.

How long were you assigned to the hospital following Hurricane Harvey’s landfall?

We ended up staying for six days.

Were there any specific preparations your unit used that were particularly helpful?

They stockpiled patient supplies such as syringes and medications days in advance to last through the hurricane because they knew we would not get supplies.

Have you experienced any other natural disasters since becoming a nurse? If so, how would you compare that experience to your experience with Hurricane Harvey?

I was a nurse during Tropical Storm Allison where everything flooded badly so I would say that this time around the Medical Center itself was much more prepared with the underground doors and shutting streets down.

 Explain your feelings regarding the uncertainty of the condition of your family, home, while you were at the hospital?

There were a lot of emotional breakdowns; a lot of people cried. The first couple of days were good, but about the third or fourth day it got very emotional. If you called your family and they didn’t answer or if you heard something on the news about an area that your family was in it just became very stressful and a lot of nurses really had some long periods of just crying; just wanting to get out and wanting to be with their families.

Do you feel that these emotions could have interfered with a nurse’s ability to care for their patients?

I don’t think we would admit that, but we did offer each other breaks during our shifts to get some alone time. I ended up on night shift so we kind of traded off letting people nap and just get away and just take moments because during the daytime a lot of people could not sleep because of the helicopters and the tornado threats.

Did you view news coverage of the damage of Hurricane Harvey during the storm? If so, how did that affect you or your colleagues?

Yes, we watched it nonstop. We were obsessed with watching it actually. It was on every TV on our unit and if you saw an area that was close to your family it really affected people. You would hear nurses say, “Oh my God, my son is in that area” or “That’s were my family is staying.” It was sad.

Did you personally have a conflict with your responsibilities as a nurse and your responsibility to your family?

Yes. You’re going to make me get emotional [with tears in eyes]. Yes, the conflict was: do I stay home and take care of my family, or do I perform my duty as a nurse and take care of my patients? I knew that my son would be with my family who would take care of him just as I would, so I found comfort in that and I was able to just be a nurse.

Were there other nurses on your unit whose family had to evacuate, and were they aware of the evacuation? 

Yes. We had a nurse that learned that her husband and mother were evacuated off their roof while she was working and had to be taken to a shelter. She was very emotional.

 Do you feel better prepared for any future natural disasters having experienced Hurricane Harvey? Why or why not?

Yes. I know now what needs to be in my disaster bag for real [laughing].

Will you volunteer as part of the predesignated ride-out team again? Why or why not?

I think I would because my son is older, and I would hate for someone who has a younger child to have to do that, but yes, I would.

Is there anything you would have done differently if you could?

Yes, I would have planned my bag better. I ran out of personal supplies, clothes, and food. I would have probably stockpiled my locker days before.

Any additional tips for other fellow RNs regarding how to personally prepare as a ride-out team member during a hurricane?

No one can prepare you or train you on how to handle the fear you will feel in your heart and the long days of relentless worry. But the same patients I was there to take care of, ironically, in a way took care of me. It’s amazing how grateful they were that we were there for them. That helped me focus on my duties and remind myself that this is what nursing is all about. We don’t run from it. We run to it. This is who we are.

Hearing nurse Heidi’s story only reminds us how amazing our nursing profession is. Nurses will continue to perform during natural disasters, but we must also remember that they too are going through this experience. They have family and friends out in the community that they cannot help. They are experiencing emotions that they will never allow their patients to see. They are having thoughts in their minds on whether they made the right decision on being a nurse or a loved one. But this is what nursing is all about. This is who we are, and this is what we do.

After the Storm: Post-Hurricane Health Hazards

After the Storm: Post-Hurricane Health Hazards

In the four weeks since Hurricane Maria ravaged the island of Puerto Rico, 76 people have fallen ill with suspected Leptospirosis, according to CNN, and two have died from the bacterial disease, which is spread through water, food, or soil contaminated with the urine of infected animals.

One patient, a 61-year-old bus driver from Canóvanas, a city in northeast Puerto Rico, became sick after drinking from a stream near his house one week after the storm, according to press reports. Within a few days, he developed a fever, turned yellow, and eventually died at a local hospital.

Outbreaks of Leptospirosis are common after natural disasters and floods and a number of the patients appear to have contracted the illness the same way the bus driver did—by drinking from local streams after being without running water in their homes. People may have also acquired the infection by bathing or wading in contaminated freshwater as the bacteria can easily enter blood stream through open cuts or wounds, or via mucous membranes in the eyes, nose, or mouth.

The island’s deadly Leptospirosis outbreak is just one example of the sort of health crisis that can arise in the aftermath of a hurricane. In the midst of what’s been one of the most active hurricane seasons in recorded history, here’s a look at some of the serious health hazards that can lie in a storm’s wake.

Pathogenic Floodwaters

When Hurricane Harvey dumped more than 19 trillion gallons of rain on the Houston area in late August, it turned low-lying streets into rivers—but the river that ran through southeast Texas was little more than a toxic cesspool tainted by human waste, chemicals, and other contaminants, according to USA TODAY.

J.R. Atkins, a former firefighter and paramedic from Missouri City, Texas, nearly lost his arm after contracting infection from the floodwaters while helping to rescue stranded neighbors. Atkins told ABC News it all started with small bug bite on the top of his arm. Within 24 hours, the small bite turned into a raging infection that was diagnosed as necrotizing fasciitis, or flesh-eating bacteria.

After a harrowing few days in intensive care, Atkins recovered from the nasty bug, but others have not been as lucky. Nancy Reed, a 77-year-old Houston woman, developed a flesh-eating bug after she fell inside her son’s flooded home and broke her arm. She died approximately two weeks later. On October 16th, a 31-year-old man who had been repairing hurricane damaged homes in Galveston also died after developing an infection in his arm with flesh-eating bacteria.

Floodwaters are a haven for microbes. Water samples taken from one flooded Houston home contained the fecal bacteria E. coli at 135 times the upper limit of what is considered safe, according to The New York Times, which organized the testing. The testing also turned up an unspecified strain of the Vibrio, a Gram-negative bacteria that thrives in coastal waters and can cause severe and sometimes fatal illness, including necrotizing fasciitis.

While there were no reported cases of flesh-eating bacteria in Florida following Hurricane Irma, several east coast beaches, rivers, and lagoons reported high levels of enteric bacteria, indicating fecal contamination. Coming into contact with the pathogens cause upset stomach, diarrhea, eye irritation and skin rashes, according to the Florida Department of Health.

Puerto Rico, meanwhile, continues to face a critical situation with 1 million people – nearly 30% of the island’s population—still lacking access to drinkable tap water, according to Weather.com. Residents there are urged to boil water before drinking and not to drink from streams, which may be contaminated with sewage, but as the current Leptospirosis outbreak indicates, some are not heeding that advice.

Mosquito-Borne Disease

Mosquitoes are the planet’s most deadly creatures, transmitting diseases that cause millions of deaths worldwide each year. Unfortunately, the conditions after a hurricane—in particular, the abundance of standing water left behind—make it ripe for mosquito breeding.

Two weeks after Irma walloped Florida, Hernando County Mosquito Control, which covers a region located about 53 miles north of Tampa on Florida’s Gulf Coast, trapped roughly 26,000 mosquitoes over the course of 16 hours. A normal catch for that time frame would be about 500 mosquitoes.

Mosquitoes can spread an array of diseases, including dengue, chikungunya, West Nile virus, and Zika. Zika can cause serious birth defects like microcephaly. There have been 40,000 cases of the disease in Puerto Rico since 2016, though in June the island declared its outbreak of the virus was over.

While there have been no reported outbreaks of mosquito-linked illnesses thus far this year, they can take some time to appear.

Researchers noted a more than two-fold increase in cases of West Nile virus in parts of Louisiana and Mississippi in 2006, one year after Hurricane Katrina devastated the region. Most individuals infected with the virus develop a fever and other symptoms that run a self-limiting course, but one out of every 150 infected individuals will develop serious illness that can be fatal.

Mold and Pollution

Mold growth can cause serious problems in the aftermath of a hurricane. In flooded homes, fungus usually develops within 24 to 48 hours and remediation is costly.

Mold exposure can be particularly harmful for individuals with lung conditions, such as asthma or chronic obstructive pulmonary disease (COPD), and evidence suggests people can develop allergy symptoms to mold in the wake of catastrophic flooding. Following Hurricane Katrina, 78% of children tested in one study had allergies to mold, compared with the typical rate of 50% in other major urban areas.

Toxic pollutants are another concern.

Damaged petrochemical refineries and other industrial facilities in and around the Houston area accidentally released millions of tons of airborne emissions after Harvey hit in Texas, according to The New York Times.

Despite reassurances from the Environmental Protection Agency that residents were not in any immediate danger, Elena Craft, a senior health scientist at the environmental Defense Fund, told the newspaper that the pollution contained “cancer-causing compounds, like benzene and butadiene” and said her group is “very concerned about people’s long-term health in the area.”

In Puerto Rico, meanwhile, thirsty and desperate residents with no access to clean drinking water have reportedly been filling up jugs with water from wells at a federally designated hazardous waste site contaminated with toxic industrial chemicals like tetrachloroethylene and trichloroethylene, a known carcinogen.

Mental Anguish

Natural disasters don’t just take a physical toll on people—they take a mental one, too.

One study found that a third of the adult survivors of Hurricane Katrina suffered from some form of storm-related mental distress, such as depression, anxiety, and post-traumatic stress disorder (PTSD), and nearly 40% of children tracked in the study were were diagnosed with a mental disorder after the storm.

It’s not just survivors who are impacted. First responders and recovery workers who are separated from their own loved ones for long periods of time can develop mental fatigue.

The psychological burden will be even greater in places like Puerto Rico, where recovery is lagging. At least nine people have died by suicide since the storm, according to the Latin Times, and residents are overwhelmed by the disaster that has left so many homeless and jobless and struggling to survive.