Each year, one in five countries has a crisis that endangers its citizens' health.1 High-profile natural disasters and humanmade emergencies in 2004 to 2006 still affect millions in Southeast Asia, Pakistan, the Gulf of Mexico, Iraq, Lebanon, and elsewhere.2 There are also about 20 ongoing armed conflicts that have caused 1,000 or more deaths.3 Political and social crises have resulted in almost 25 million internally displaced people and more than 10 million refugees.4,5

With this in mind, the World Health Organization (WHO) met in Geneva in November 2006 with a dozen global nursing leaders to identify the status of emergency preparedness and response in nursing. Ala Alwan, assistant director-general, and Jean Yan, chief scientist for nursing and midwifery, led the meeting, which was hosted by Princess Muna al-Hussein of Jordan, WHO patron for nursing and midwifery.

A report of the first Consultation on Nursing and Midwifery Contributions in Emergencies is now available from WHO (see http://www.who.int/hac/events/22_23November2006/en/index.html). The most important issues to emerge from the meeting were the following:

The global nursing shortage. Many countries have a critical shortage of nurses and midwives.6 Nurses around the world struggle with poor working conditions and low salaries, while the hope of better wages lures many to more developed countries. In most countries emergency preparedness is lacking. Yet nurses are likely to be among the first to respond to health emergencies. Therefore, nurses must be brought into emergency planning, train colleagues, and assume a hands-on role in responding.

Nursing competencies. In 2003 the International Nursing Coalition for Mass Casualty Education (since renamed the Nursing Emergency Preparedness Education Coalition) developed a list of competencies for nurses responding to mass casualties (see http://www.nursing.vanderbilt.edu/incmce/competencies.pdf).7 This document and others from the International Council of Nurses (ICN) and the University of Hyogo, Japan, were reviewed, and meeting participants endorsed a "unified competency model."

Humanitarian emergencies create challenges different from those that nurses usually face, particularly if there is political instability, war, or social disruption. For example, it may be necessary to treat people who have no health records, under conditions where documentation is difficult or impossible. At the same time, nurses must be assured of legal protection should events require them to work beyond the usual scope of practice.

In the early phase of such circumstances, nursing activities are about saving lives. Less well recognized but at least as important, nurses may contribute to rehabilitating and protecting health.

Participants made the following recommendations. For teaching and curriculum:

* Prepare student nurses before an emergency occurs.

* Teach emergency care as part of mental health training and chronic disease management, including support for nurses and other caregivers.

* Provide in-service education in crisis management.

* Develop learning materials and teaching modules.

For organizational responses:

* Hold practice exercises.

* Encourage volunteer coordination before emergencies.

* Promote the roles of nurses and midwives in emergencies via public relations.

* Develop an international registry of expert consultants.

Other efforts. After the Geneva meeting, nursing groups began implementing recommendations. For example, the Jordanian Nursing Council designed an undergraduate curriculum on disaster nursing, to be disseminated in the Eastern Mediterranean region.

In the past year, the ICN launched a disaster response network for nurses in Southeast Asia and the Western Pacific region, aiming to strengthen their ability to respond to disaster-stricken populations. The network's first meeting was held in Yokohama, Japan, in June. The inaugural session focused on mental health, stress management for caregivers, and professional regulatory issues. (For more on ICN's disaster preparedness efforts, see http://www.icn.ch/disasterprep.htm; for the ICN's Position Statement on Nurses and Disaster Preparedness, see http://www.icn.ch/psdisasterprep01.htm.)

The World Association of Disaster and Emergency Medi-cine (WADEM) is also working on issues related to disaster nursing. WADEM publishes Nursing Insight (see http://wadem.medicine.wisc.edu/nursinginsight.htm), a biannual nursing supplement to Prehospital and Disaster Medicine (see http://pdm.medicine.wisc.edu). The organization also plans to develop an expanded nursing Web page and create a roster of disaster-nursing specialists.

Richard M. Garfield, DrPH, RN, FAAN

The Henrik H. Bendixen Clinical Professor of International Nursing in Columbia University's School of Nursing, New York City; contact author: [email protected]

REFERENCES