Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national, Web-based survey of Canadian nurses was conducted to assess perceptions of preparedness for disasters and access to support mechanisms, particularly for nurses in emergency and critical care units.

The following hypotheses were tested: (1) nurses' sense of preparedness for infectious disease outbreaks and naturally occurring disasters will be higher than for chemical, biological, radiological, and nuclear (CBRN)-type disasters associated with terrorist attacks; (2) perceptions of preparedness will vary according to previous outbreak experience; and (3) perceptions of personal preparedness will be related to perceived institutional preparedness.

Nurses from emergency departments and intensive care units across Canada were recruited via flyer mailouts and e-mail notices to complete a 30-minute online survey.

A total of 1,543 nurses completed the survey (90% female; 10% male). The results indicate that nurses feel unprepared to respond to large-scale disasters/attacks. The sense of preparedness varied according to the outbreak/disaster scenario with nurses feeling least prepared to respond to a CBRN event. A variety of socio-demographic factors, notably gender, previous outbreak experience (particularly with SARS), full-time vs. part-time job status, and region of employment also were related to perceptions of risk. Approximately 40% of respondents were unaware if their hospital had an emergency plan for a large-scale outbreak. Nurses reported inadequate access to resources to support disaster response capacity and expressed a low degree of confidence in the preparedness of Canadian healthcare institutions for future outbreaks.

Canadian nurses have indicated that considerably more training and information are needed to enhance preparedness for frontline healthcare workers as important members of the response community.

The Impact of Event Scale Revised (IES-R) has been used in various epidemiological studies to assess the prevalence of post-traumatic stress disorder (PTSD). Previous studies using the IES-R Japanese version to assess the mental health of firefighters were based on the premise that firefighters had experienced a traumatic event(s) as a matter of course. However, use of the IES-R-J does not indicate whether or not a traumatic event was experienced. The purpose of this study is to clarify the differences between: (1) IES-R-J high and low score groups; and (2) those who report symptoms similar to those of PTSD with and without having been being exposed to a traumatic event.

Questionnaire packets distributed to all 157 workers in a Japanese fire station included the IES-R, the Japan Brief Job Stress Questionnaire, a questionnaire regarding traumatic event experiences, and demographic questions. Participants who scored ≥25 points on the IES-R-J scale were defined as the PTSD high risk (HR) group; those with scores <25 points as the PTSD low risk (LR) group.

One hundred thirty-one of the 157 subjects (83.4%) responded to the questionnaire; three were excluded from the analysis because of missing data. The mean total IES-R-J score was 14.9 ±15.2. Twenty-eight subjects scored in the PTSD HR group (≥25); 100 scored in the LR group (<25). A total of 54 (42.2%) participants had experienced a traumatic event; 57.8% had not. In the HR group, 14 subjects had experienced a traumatic event and 14 had not. Participants who had experienced a traumatic event reported a higher incidence of intrusion/re-experience symptoms than did those who had not experienced a traumatic event. The level of social support significantly affected the risk for PTSD.

Firefighters who scored ≥25 on the IES-R-J and, thus, considered to be at high risk for the development of PTSD, were less confident about their health, experienced more job stressors and had less social support than did those whose IES-R-J scores were <25. Having experienced a traumatic event was reported by only 42% of all the participants and by only 50% of those in the high risk PTSD group.

Although the IES-R is an easily-administered tool useful in epidemiological studies evaluating psychological stress, it is recommended that the questionnaire be amended to include a question regarding the existence of a threatened experience or event and to analyze the data using positive and negative predictive value methodology.

A long and protracted civil war compounded by the occurrence of nature-related disasters have forced thousands of Somalis to take refuge in camps for internally displaced persons (IDPs) to escape violence and seek shelter. Dwellers of these camps have limited accessibility to and affordability of the fractured healthcare facilities located in nearby towns. A free, outreach, mobile, reproductive healthcare delivery system staffed with nurses and using an ambulance guided by a global information systems (GIS) map was established to address the accessibility and affordability issues hindering provision of quality reproductive healthcare to the women in the IDP camps and in the outskirts of Baidoa City, Somalia.

All 14 IDP camps in Baidoa City were visited to determine the number of families/huts, and to acquire their global positioning system (GPS) central point locations. Global information systems (GIS) shape files containing major roads, river, and dwellings, and straight-line distances from the base clinic to each IDP camp were computed. The objective of creating and using this specially designed map was to help nurses in determining which camps realistically could be visited on a given day, and how best to access them considering the security situation and the condition of rain-affected areas in the city.

Use of the GIS map was instrumental in facilitating the delivery of healthcare services to IDPs and ensuring that resources were adequately utilized. Free healthcare services were provided each work day for the month long duration of the project; 3,095 consultations were provided, inclusive of 948 consultations for children under the age of 16 years, and delivery of three babies.

Creation and use of a simple, need-specific GIS map in this pilot project effectively aided the logistical planning and delivery of mobile, outreach reproductive health services by directing the ambulance and nurses safely to accessible IDP camps in an area marred with long and protracted disasters from both natural and human causes.