The purpose of this presentation is to compare the lessons learned in acute nursing care in the post-disaster settings of Aceh Jaya, Indonesia (2004) and Port-au-Prince, Haiti (2010). The impact of such disasters disproportionally affects populations made vulnerable by poverty, marginalization, and structural violence. The recognition of these vulnerabilities heightens the role of the nurse as an advocate for the ill and injured. In addition, the lack of adequate human and material resources on all levels necessitates insisting on best practices for patient care despite the resource constraints. Consideration of best practices begins with rigorous personnel selection of nurses adequately trained in emergency/critical care, complex humanitarian emergencies, and disaster response. A proficient level of resource-specific triage knowledge is required to adequately provide the most effective care to patients. Not infrequently, disaster nursing care involves being tasked with a clinical skill or procedures that would be outside the scope of practice in the home country. While the expansion to such practices often is justified by need, an ethical framework demands consideration of the central tenet of “first do no harm”. A heavy burden of coordination among other caregivers, family, and the local staff is required by nurses in this environment. The substantial challenges include communication and continuity of care during the initial response phase among multiple partners with varied backgrounds and goals. Drawing from experiences in Haiti and Aceh, this presentation seeks to define the best practices in disaster nursing care and explore the ethical considerations that arise in such challenging environments.

In the blink of an eye, a disaster caused by either natural or man-made hazard can change the sociocultural, psychological, physiological, and geopolitical integrity of all those that are directly and indirectly impacted. Disasters occur in every part of the world and are nondiscriminatory. Nurses, as the largest group of healthcare providers worldwide, are and should be at the center of disaster planning, management, and evaluation. Nurses are there when prevention is needed, during the crisis, and when the cameras and media are gone and the real work of recovery begins. Nurses remain there when the evaluation of the response, in its broadest sense, occurs and when recommendations must be made for applicable modification prior to the next disaster, as nurses are aware there will be more on the way somewhere in the world. As the second largest nursing organization in the world, the Honor Society of Nursing, Sigma Theta Tau International (STTI), has committed to being a leader in improving the health of the world's citizens. This leadership extends to being at the forefront of disaster planning, management, and evaluation. Through its member's use of knowledge, research, scholarship, service, and learning, STTI has created an environment in which they will impact the shaping of how nurses plan for, respond to, and evaluate disasters globally. This presentation will highlight the expertise that STTI has in the area of disaster planning, management, and evaluation, as well as the work that leaders are conducting to make an impact on the world during times of such crises. Discussion also will center on how STTI is continuing to provide leadership, education, service, and research opportunities in the area of disaster planning, management, and evaluation that can be applied throughout the world.

Emergency nurses have key roles in responding to healthcare disasters. Emergency nurses often complete postgraduate qualifications in their area of specialty to equip them with a breadth and depth of knowledge to respond to the challenges and complexities of emergency nursing care. However, little is known about the disaster preparedness of emergency nurses in Australia. More specifically, the educational preparedness and training for disaster nursing roles is not well understood. This purpose of this study is to describe the disaster content of Australian postgraduate tertiary emergency nursing courses as a means of better understanding emergency nurses' educational preparedness for disaster. An exploratory, descriptive approach was used to survey postgraduate tertiary emergency nursing course convenors. Data were collected from course convenors by structured telephone interview. Questions included: (1) nursing background; (2) demographics and disaster experience of course convenors; (3) course type, duration and mode of delivery; and (4) the type and amount of disaster content. Currently, 12 universities in Australia offer postgraduate courses specific to Emergency Nursing, ranging from Graduate Certificates to Masters Degree level. Of these universities, 10 participated in this research project. This presentation will report on the demographics of course convenors, including their disaster education and experience. However, the focus of the presentation will be on the review of the course content. Seven courses had some disaster content, while three had none. The disaster content in these courses varied in both content and duration. Three had learning objectives, and one had an assessment item related to disasters. Five had recent modifications relating to disaster content; this was in response to real-world events, such as terrorism and communicable diseases. This research highlights that the disaster content in Australian postgraduate emergency nursing courses varies. This finding supports the need for national consistency and supporting framework for disaster content in post-graduate courses. The 2009 Ben Morley Scholarship, a financial award sponsored by the College of Emergency Nursing Australasia, supported this research.

The year 2010 brought an unprecedented public health response to the novel H1N1 influenza pandemic. Included in that response were colleges and universities across the globe. At universities not associated with medical centers, medical directors of student health looked to nursing faculty or nurse practitioner directors of student health for leadership. From the day novel H1N1 was formally declared a public health emergency, Arkansas State University utilized a nurse faculty member with expertise in homeland security as its Incident Commander. A portion of the nurse's time was dedicated to managing the incident. The nurse was positioned to provide guidance and lead the response with an understanding of university structures as well as business and academic continuity. From the beginning, the nurse utilized the Incident Command System to manage the response. Portions of the University's Incident Command structure were activated and Incident Command meetings were held no less than every two weeks. A tabletop exercise was developed specifically for a university setting and to give University officials practice at pandemic management. The nurse's clinical focus and pre-established relationships with disaster response and public health officials allowed critical access to important resources that the University would have otherwise gone without. She guided the University through redefining their pandemic plan, including assisting residence life in establishing alternative housing for sick students. An on-line reporting system was developed that was utilized by faculty, students, staff, and other concerned constituents. A public awareness campaign on the campus was instituted and 1,000 posters were posted around campus encouraging sick students to stay home and/or seek medical care. The World Health Organization, (US) Centers for Disease Control and Prevention, and Department of Education guidelines were monitored and implemented. Two mass-immunization clinics were held on the campus with > 7,000 immunizations provided.

“Facilitating disaster nursing research in Oceania Region” Natural disasters in the Oceania region and surrounds include for example earthquakes, volcanic eruptions (Rabaul, PNG, 1994, Merapi, Indonesia 2006), tsunamis, floods,(Indian Ocean 2004) fires, drought (Australia, 2009) and also pest plaques and pandemics which affected the broader international community. Between 1980 and 2008, there were 380 disaster events reported in the Oceania region in which 4,450 people died. That is approximately 154 deaths and 668,786 people affected at a cost of approximately $US 889 million per year. However despite this significant number of deaths and injuries, there is limited reporting on the nursing experience during such disasters or the impact of nursing on communities during response and recovery. This is due to the prioritised clinical focus of nursing resources of most countries during these events. A network of authors and researchers is being established in the area to support the reporting of nursing research in developing countries such as Papua New Guinea, Fiji, the Solomon Islands, Vanuatu, and Indonesia where nurses receive little post basic education, have limited opportunities to review the evidence for practice in disaster and emergency nursing, yet are regularly required to support the multidisciplinary disaster health team without essential support from the nursing research community. The network is essentially web-based and consists of a translational research approach via a network grid of researchers in response to a disaster event. Researchers from neighboring countries not clinically involved in the event respond by discovering and accessing data, analysing and reporting through a portal that enables timely reporting for discussion, publication, e-learning and dissemination of contemporary disaster nursing practices. This paper will report on the development of the network and its nexus with the WADEM Nursing Research Committee.

To develop a common structure for reports on health crises and critical health events guidelines have recently been published (Kulling et al 2010). They try to capture the experiences gained and for promoting a standardized methodology for sharing results and lessons. If future reporting follows common standards, then the documented findings would be comparable and could be used to learn and apply lessons within an individual field of activity and to apply those lessons learned also to other related preparedness activities. It could also facilitate the implementation of joint activities and joint reports involving different sectors. The development of this proposed method for common reporting on health crises and critical health events has been derived mainly from the following processes: (i) Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style; (ii) the Swedish Disaster Medicine Study Organization (KAMEDO); (iii) the Swedish Emergency Management Agency network of observers; (iv) the WHO Regional Office for Europe project (supported by the EU Health Programme) ‘Support Health Security, Preparedness Planning and Crisis Management in the EU, EU accession and neighboring (ENP) countries’ including expert consultations. The guidelines include the following headlines: Title, Preface, Authors, Executive Summary, Introduction/Material/Methodology, Pre-Event Status (Background, Preparedness, Hazard(s)involved, Risks, Vulnerability, Resilience), Health Crises and Critical Health Events (Damage, Consequences of Damage (Changes in Functions/Disturbances), Responses (Relief Responses, Recovery Responses), Development, Discussion, Lessons Identified and Actions Recommended, Conclusions, References, Appendices, Keywords, Index, Abbreviations. Pilot testing is suggested followed by an extensive review process. The guidelines should be supplemented further with determinants and indicators when the guidelines are used for in depth reporting to evaluate crisis response operations. Reference Kulling P, Birnbaum M, Murray V, Rockenschaub G. Guidelines for Reports on Health Crises and Critical Health Events.

Disaster reports are common in the literature. Accurate and complete reporting assists readers and researchers in developing best practices. There have been notable efforts, such as the Utstein Template, to standardize the language of disasters and promote consistent use of definitions. However, case reports are complicated by the presence of four dominant types recognized in the literature. Moreover, the disciplines of medicine, public health, and disaster management differ in origins, definitions, research paradigms, and tools of evidence-based decision-making. Finally, biomedical journal guidelines for authors writing disaster case reports have lacked the rigor of standards associated with observational studies (2007 STROBE statement, 2010 MOOSE statement), or with randomized controlled trials (1996 CONSORT statement, 1999 QUORUM statement). This paper examines current efforts to intensify the rigor of future disaster case reports through uniform reporting requirements for authors. The initial workgroup comprised editorial board members of two biomedical journals indexed in the US National Library of Medicine—Prehospital and Disaster Medicine, and Emergency Medicine Australasia. The workgroup members self-selected based on extensive disaster field experience as technical advisor with governmental, non-governmental, Red Cross and UN agencies. The workgroup identified key information needed to understand the context, structure, process, and outcome/impact of disaster field interventions. Then, the workgroup organized this information in thematic domains. Consensus guidelines emerged for Reports of Field Interventions in Disasters and Emergencies (CONFIDE). The CONFIDE Statement addresses 16 keys areas within seven domains, including: field authorization for access, field logistics, initial assessment, clinical epidemiology, and funding. The Statement was first published in December 2010, at which time, the authors began integrating the guidelines with biomedical journal instructions for authors. The paper details current efforts to broaden editorial acceptance of the guidelines, implications for future authors, and potential benefits to the disaster medicine community.

The Tel Hai college Department of Social Work established this program as part of its community commitment to ensure that persons with skills in emergency mental health / trauma intervention will be available to the community as first responders when needed. The main goal of the STSP: Training Social work students As First Responders with Very High Professional Standards of Emergency as well as Long Term Mental Health Interventions Qualifications. This program enables the students to integrate between theory and hands-on basic and advanced skills in stress & trauma interventions – from the help to a single traumatized person to mass disasters involving more complex interventions. In addition, program underlines and empowers the students self efficacy and resilience. The studies are carried out in 4 main channels: A. Academic studies and advanced professional workshops. B. Outdoor drills with other help and rescue units: MDA (EMS), IDF, Police, Israel fire and rescue services, local and national rescue units) C. Volunteering in community trauma / first responder units D. Emergency mental health interventions during real time events (Last one: Emergency interventions among the evacuated families during the mount Carmel bushfire) Student's Skills Acquired During the STSP • Theoretical & practical knowledge of the stress & trauma development process. • Differentional diagnosis of the trauma stages (From ASR to C-PTSD). • Identifying all sources of resilience and coping strategies. • Basic & advanced crisis and disaster intervention methods. • Crisis & disaster management & command • Professional self confidence, Independency & Creativity, leadership and leading capabilities. The program, its benefits and latest drills and real time intervention will be discussed as well as demonstrated with videos.

Integration of Psycho-social Social Support and Mental Health Services in to National Disaster Management Guidelines India is vulnerable, in varying degrees, to a large number of natural as well as man-made disasters and also a high risk country for disasters due to expanding population, urbanization and industrialisation, development within high-risk zones, environmental degradation and climate changes. The creation of National Disaster Management Authority (NDMA) in 2005, as the apex body for disaster management, has brought out a paradigm shift in the area of disaster management. One of the important mandate of NDMA is to issue National Disaster Management Guidelines (NDMG) to the ministries/ departments to assist them to formulate their respective Disaster Management (DM) plans. In this direction NDMA has issued number of NDMG on different themes to provide basis of preparation of DM plans at different levels. There are policies & guidelines on Psycho-social Support and Mental Health Services (PSSMHS) in disasters at the international level in the form of Inter Agency Standing Committee guidelines (IASC) which advocates PSSMHS in disasters. In India there was no such policy which streamlines the Psycho-social Support and Mental Health Services in Disasters. During preparation of various National Disaster Management Guidelines, one remarkable factor noticed was the need for psycho-social care, subsequently preparation of NDMG on Medical Preparedness and Mass Causality Management brought out an overwhelming consensus to formulate a separate NDMG for PSSMHS. In order to translate the critical need for psycho-social care and support into guidelines, NDMA adopted a mission-mode approach for integrating PSSMHS in disaster response by involving participatory and multi step methodology to formulate NDMG on Psycho-social Support and Mental Health Services in Disasters.

The ongoing shelling of missiles on the city of Sderot in Israel for the past 8 years have caused damage in terms of life and property as well as have put more than 25,000 residents under significant and ongoing threat. A recent study examining the impact of living under these conditions has revealed that 28.4% of the area residents suffer from PTSD and 75%–94% of the children reported to experience posttraumatic symptoms (Gelkopf, Berger, Bleich, Cohen, submitted). Despite the psychological needs of the residents, mental health service utilization has been sparse due to many residents not feeling safe to leave their homeland fear the stigmatization in attending public mental-health clinics. In order to resolve this dilemma, we have developed a community home-based family intervention delivered through a mobile unit of professionals who provide mental-health services for to traumatized families in their homes. The model incorporates family systemic approach with trauma-focused cognitive-behavioral technique and narrative strategies. I will outline the model and present an evaluation of its efficacy in reducing PTSD and in improving daily functioning in adults and children. I will also describe several cases illustrating the model. Finally, we conclude that such a model may be useful in providing mental-health services in major disaster, such as Tsunamis, earthquakes and floods, particularly in developing countries where mental health capacity is limited and where local populations will not always have the means or be able to reach clinics.

The earthquake in Haiti and its consequences highlighted the need to enhance knowledge and skills for community intervention in situations of disaster and acute trauma. The large number of homeless people concentrated in enormous refugee camps has made such an investigation possible. In the lecture, we will present a model for empowerment intervention with victims of community disasters. The model is based on analyses of three cases in which psychosocial interventions were conducted by the investigators: the Tsunami in Sri Lanka, work at refugee camps in Georgia, and the earthquake in Haiti. Principles of the Model The more extensive the casualties are, the less relevant individual intervention will be. Entering an unfamiliar culture requires collaborative professional work with local residents. Intervention in a large-scale disaster needs to be based on an interdisciplinary perspective in terms of planning, preparation, and implementation. It is assumed that the intervention will be short-term, and a specific length of time is allocated for therapeutic agents to provide assistance. This approach was adopted in light of the limited resources at our disposal, and in an attempt to minimize dependence in the relationships between the therapeutic agents and the victims. An attempt is made to enhance efficacy for effective coping with changing needs that emerge in the wake of the disaster. An attempt is made to prevent CPTSD, which can inhibit the functioning of the community residents. We will present these principles and describe how they were implemented in community intervention at two refugee camps in Haiti following the earthquake there, and at a refugee camp in Georgia.

Although most victims of disasters recover on their own, a minority of survivors, uniformed services, and relatives develop long-term disaster related psychic disorders such as Posttraumatic Stress Disorder (PTSD). Especially this subgroup should receive timely and appropriate psychosocial help. In many EU countries is offered post-disaster psychosocial care by a variety of caregivers (i.e. professionals and volunteers, NGOs, church or commercial organizations). Therefore, European standardization of providing post-disaster psychosocial support is currently required. The presentation describes the project supported by the European Commission and named European Guideline for Target Group Oriented Psychosocial Aftercare – Implementation (EUTOPA-IP), supported by the European Commission. EUTOPA-IP has integrated two materials: German “Target Group Intervention Programme” and Dutch “Multidisciplinary guideline”, also with the experiences of experts in the area of psychosocial support from the EU countries. Main target is to develop a guideline for the uniformed services on the basis of the Multidisciplinary guideline for early psychosocial interventions, the adaptation of the Target group Oriented Intervention Program (TGIP) to the International Classification of Functioning, Disability and Health (ICF) and preparation and implementation of training program for various professional groups. The project aims at standardization of psychosocial aftercare in case of disasters as well as at the development of European network based on current findings in psychotraumatology. Early screening, supportive context, early preventive and curative psychosocial interventions, management of interventions, implications for the clinical field and future research are topics discussed in the project. Project consortium:

• – City of Cologne (Germany)

• – Centre of Psychotraumatology (Germany)

• – Impact (The Netherlands)

• – Spanish Society for Psychotraumatology and Traumatic Stress (Spain)

• – Charles University in Prague (Czech Republic)

• – Capital City of Dusseldorf, Department of Public Health (Germany).