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Exploring the role of nurses during the Black Saturday and Victorian bushfires of 2009 in Australia
1. Exploring the role of nurses during the Black Saturday and Victorian bushfires of 2009 in Australia Mr Shane Lenson: Senior Nurse Advisor, Royal College of Nursing, Australia Mr Jamie Ranse: Assistant Professor, Faculty of Health, University of Canberra, Australia Chief Nursing Officer, St John Ambulance Australia
15. Health Disaster Response Australia's health care response to disasters Familiar with the threat of natural disasters St John Ambulance Australia Clinical accreditation framework Health care professionals in St John Role of St John in the bushfires Cross border arrangements
16. Aim To describe the clinical experience, disaster training / education, and disaster experience of nurses who participated in the February 2009 Victorian Bushfire response and recovery.
17. Methodology Design Population and sample Participant recruitment Data collection Data analysis Protection of human participants
18. Participant demographics Gender Male 7 Female 4 Years experience as a nurse 16 years (2 -45) Years experience as a member of St John 17 (3 -40)
19. Thematic analysis Being prepared Having an appropriate level of training Having enough resources Having adequate clinical experience Expansive Roles Minimal clinical care Emotional supporter Nurse as coordinator Problem-solver
20. Having an appropriate level of training “I think I’m pretty well okay in [terms of] training for disaster....I’ve done alot of courses in my time [with St John]” “I felt quite comfortable and quite confident that I was able to deal with whatever was going on ... since my time with St John I have been to bushfires, floods and many large outdoor public events”
21. Having enough resources “We packed in as much medical gear as we could put into [the car], that including the doctor’s bag, all the resuscitation equipment ... boxes, extra IVs...” “We had routine stock deliveries ... donations from chemists, so we had a myriad of dressings and lots of solutions and treatments, and things that anyone thought might be helpful they’d donate. We had a lot of resources at our disposal. Probably too much, as we used very little...”
22. Having adequate clinical experience “I was paired with paramedic students ... there was [also] a doctor who volunteered so we’d go out to patients homes if they weren’t prepared to come in.”
23. Minimal clinical care “[I treated] ... relatively minor things, headache, a scratch from jumping off the truck .... a lot of eye rinses, minor burns...” “People were worried about their medical conditions ... ‘I haven’t had my blood pressure tablets, is my blood pressure okay’... “
24. Emotional supporter “My nursing experience probably helped a little bit more with the emotional side of people presenting ... people were distressed ... counselling [and] supporting skills that you learn through nursing [assisted me].” “... a lot of the time we were just there to talk to them, just be there as somebody to listen to what they were saying because they didn’t actually need first aid per se.”
25. Nurse as coordinator “We did a great deal of coordinating...making phone calls and organising services... the GP from Whittlesea had gone down to the disaster relief centre and was ... writing scripts. The chemist had opened after hours to allow people to go and get their scripts filled” “In the EOC ... I liaised with healthcare professionals to find out who was available, and at what notice, for sudden team medical deployment.”
Victoria is the second most populous state in Australia.[1] Geographically the smallest mainland state, Victoria is bordered by New South Wales to the north, South Australia to the west, and Tasmania to the south237,629 km2 (6th)91,749 sq mi5 Million people70 Melbourne, another 20% in large rural cities and the rest in regional/remoete areas
The Black Saturday bushfires[7] were a series of bushfires that ignited or were burning across the Australianstate of Victoria on and around Saturday 7 February 2009. The fires occurred during extreme bushfire-weather conditions, and resulted in Australia's highest ever loss of life from a bushfireAs many as 400 individual fires were recorded on 7 February. Following the events of 7 February 2009 and its aftermath, that day has become widely referred to as Black Saturday.
173 deaths414 InjuredOf the people who presented to medical treatment centres and hospitals, there were 22 with serious burns and 390 with minor burns and other bushfire-related injuries
450,000 ha (1,100,000 acres) burnt7,562 people displacedOver 3,500 structures destroyed,
Over 11,800 head of livestock25,600 tonnes (25,200 LT; 28,200 ST) of stored fodder and grain32,000 tonnes (31,000 LT; 35,000 ST) of hay and silage[152]190 ha (470 acres) of standing crops62,000 ha (150,000 acres) of pasture[152]735 ha (1,820 acres) of fruit trees, olives and vinesOver 10,000 kilometres (6,200 mi) of boundary and internal fencing destroyed or damaged
A week before the fires, an exceptional heatwave affected southeastern Australia. From 28–30 January, Melbourne broke records by sweltering through three consecutive days above 43 °C (109 °F), with the temperature peaking at 45.1 °C (113.2 °F) on 30 January, the third hottest day in the city's history.Melbourne hit 46.4 °C (115.5 °F), the hottest temperature ever recorded in an Australian capital city
humidity levels dropped to as low as six percent. The McArthur Forest Fire Danger Index reached unprecedented levels, ranging from 120 to over 200
hot northwesterly winds in excess of 100 kilometres per hour (62 mph)
On 6 February 2009—the day before the fires started—the Premier of VictoriaJohn Brumby issued a warning about the extreme weather conditions expected on 7 February: "It's just as bad a day as you can imagine and on top of that the state is just tinder-dry. People need to exercise real common sense tomorrow".[18] The Premier went on to state that it was expected to be the "worst day [of fire conditions] in the history of the state"
It was estimated that the amount of energy released during the firestorm in the Kinglake-Marysville area was equivalent to the amount of energy that would be released by 1,500 Hiroshima-sized atomic bombs
Design This research used telephone interviews as a means of data collection, to explore and describe nurses’ experiences of their role during the Victorian bushfire of 2009.Population and sampleThe population included volunteer nursing members of St John Ambulance Australia. The sample included participants who were participants who had real-life experience of actively participating in the response and/or recovery to the Victorian bushfires of 2009.Participant recruitmentContact details were obtained from an existing St John Ambulance Australia membership database. Potential participants were posted a package containing; an information sheet about the research and a consent form. Written consent was obtained from all participants of this research.Data collectionA single semi-structured telephone interview as a means of data collection. The interviews gathered information pertaining to participant demographics, nursing characteristics, previous education and training, the nurse’s roles and available resources during the bushfires. Protection of human participants This research project was approved by the St John Ambulance Australia Human Research Ethics Committee. Allpartivpant date was deidenfitfed.
Participants stated that their nursing background had an appropriate level of education and training to undertake a nursing role in the pre-hospital environment. Additionally, they stated that their prehospital experience with St John Ambulance gave them the confidence with their in-hospital expertise to work in the pre-hospital environment.
When nurses were preparing for deployment to the bushfire affected areas, they ensured they were adequately resourced. This would result in them ‘packing the car full’ with medical equipment and stock._____________________________However, they would not use most of these resources, as these resources were a random, non-strategic selection of items that were perceived to be of potential benefit. In addition, to nurses bringing resources from their organisation, resources were supplied or donated by the communities when they arrived at their deployment destination. On occasions, the local pharmacy or hospital provided additional resources for nurses to use.
Participants had a variety of clinical experience, in terms of both years of employment as a nurse, and in the variety of roles they have undertaken in their employment. All had the perception that they could undertake a role in the pre-hospital bushfire environment. In the pre-hospital bushfire environment, nurses worked in a variety of clinical models. At times, nurses worked in an autonomous role or in teams with medical and paramedical personnel, both from St John Ambulance Australia or within existing health systems resources.
In the period following Black Saturday, as fires continued to burn, nurses stated that they primarily treated minor injuries and illness, and that fire fighters constituted the patient population with these ailments. ____________________________________________Additionally, participants described having a primary health care role for members of the bushfire-affected community. Whilst this was not the major patient workload, they felt that this was an important contribution to the community.
In addition to providing clinical care, nurses provided emotional support to members of the community. This was not conducted during organised debriefing sessions, but occurred haphazardly.
Some participants described undertaking a role that mirrored their hospital employment. Such roles included a hospital coordinator-like role, in which nurses would coordinate the movement of patients, stocktake equipment and telephone other evacuation centres to determine what equipment and resources were available in the area.__________________________Nurses added value to other areas of the response, such as a contribution to the Emergency Operation Centre (EOC) of St John Ambulance Australia, where nurses would undertake a variety of command, liaison, administration and logistic positions.
