Last month, the nation marked the 10 year anniversary of Hurricane Katrina reminding us of the powerful and destructive impact disasters exert on people’s lives. In a similar vein, a recently released book Nurses and Disasters: Global Historical Case Studies (Editors Arlene W. Keeling and Barbra Mann Wall), examines the role of nurses in responding to historic and recent global disaster such as Hurricane Katrina. Given the Katrina anniversary and the relevance of understanding responses to disasters, I interviewed the editors of Nurses and Disasters some questions about the book and why it should be read.

1. What inspired you to put together a book on nurses and disasters?

The inspiration for Nurses and Disasters: Global Historical Case Studies came from three sources.  First and foremost was the success of our first book, Nurses on the Front Line: When Disaster Strikes, 1878-2010, on nurses’ roles in disasters in the United States. There was worldwide interest in that book and after its translation into Chinese, we were all too cognizant of the fact that we had only written about disasters in the US — and clearly, disasters are occurring on an almost daily basis around the world.  The second impetus for this book was the Ebola crisis and the attention that American nurses received when they succumbed to the virus as opposed to nurses in Africa. The inattention to the nurses who suffered and died from the disease in Africa was striking, and we wanted to draw attention to the race, gender, and class disparities that persist today in the health care arena.  Thus, we highlight the Ebola crisis in the preface and conclusion of the book.  The third factor that drove our decision to write Nurses and Disasters was the fact that there has long been a silence associated with nurses’ roles in the major disasters occurring during World War II.  While some attention has been paid to them for their roles as nurse anesthetists on the European front, and their heroic efforts in Bataan, little attention has been given to the actions of the British nurses during the Blitz, the nurses who attended trauma patients in Pearl Harbor, or the Japanese nurses’ courageous efforts when they too were victims of the atomic bombing.  Giving voice to these nurses was very important to us.

2. Did you uncover any surprises about the role of nurses during disasters that you either didn’t know about or believed had been understudied or misunderstood by previous histories on disasters?

Some findings were not surprising, such as disparities that occurred in responses to the indigenous people in Alaska, who did not receive needed help during the flu epidemic. What hasn’t really been discussed much when one thinks about disasters is how nurses themselves were under attack as well, making it very difficult to implement meaningful responses to the evolving chaos. Certainly after 9-11, firefighters became the heroes because they persevered in their roles despite the risks, and many died as a result. Similarly, nurses were under attack in many of the case studies highlighted in the book. The Japanese nurses after the Hiroshima bombing who also were injured, the nurses caring for those with SARS and who contracted the disease themselves, nurses in the Bar Harbor fire – all of those nurses continued to work as the disaster unfolded. For various reasons, they saw it as their duty to continue working holding to their obligation to care. Yet the chapters point to the consequences of such duty to care. They call attention to nurses’ ethical and moral dilemmas and conflicts among their personal, family, and professional obligations. They felt compelled to “nurse.” Yes, their actions were heroic, but the price nurses paid to care were great, as some died, others became ill themselves, while others suffered lasting survivors’ guilt. These issues need further study.

3. What would you say are the main policy implications coming from the findings of Nurses and Disasters?

The policy implications that emerge from our research and documentation of nurses’ roles in disasters are quite simple. Nurses – who serve on the front lines of disasters—should be a part of local, state and federal disaster preparedness councils along with physicians and other health care providers, first responders, fire and rescue.  Care should be coordinated; lines of communication clear; and supplies available.  Nurses should be educated as to their role and how to keep themselves safe, and should be provided the proper equipment and support to do so.

4. Who should read this book and why?

The audience for Nurses and Disasters is huge. Of course nurses, physicians, policy makers, historians of nursing and medicine and women represent the usual audience for a book on this topic but also nursing students and students studying the health care system are finding both our books on nursing in disasters to be very interesting and pertinent. Thus we encourage faculty members to require the book for courses in public health, leadership, nursing issues, and other courses.

Interview of Arlene W. Keeling , PhD, RN, FAAN, The Centennial Distinguished Professor of Nursing, University of Virginia School of Nursing & Barbra Mann Wall, PhD, RN FAAN, Thomas A Saunders III Professor in Nursing, University of Virginia School of Nursing conducted by Jean C. Whelan, Editor-In Chief, Echoes and Evidence blog