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Moments when Time Stood Still: Nursing in disaster

D’Antonio, Patricia PhD, RN; Whelan, Jean C. PhD, RN

AJN, American Journal of Nursing: November 2004 - Volume 104 - Issue 11 - pp 66-72

A look at the history of nursing during disasters.

Patricia D’Antonio is an adjunct associate professor of nursing, and Jean C. Whelan is a postdoctoral fellow at the Center for Health Outcomes and Policy Research, at the University of Pennsylvania School of Nursing in Philadelphia. Contact author, Jean C. Whelan:

As the hours passed on September 11, 2001, many nurses took comfort in knowing that thousands of their colleagues and other rescue and relief workers were mobilized to care for victims of the disaster. As they triaged and treated patients, calmed and comforted families, and coordinated the flow of material assistance, those nurses carried on the nursing tradition of disaster relief.

Yet, historically, formally trained nurses had to prove their worth in disaster relief, as conventional wisdom long held that in the chaos and confusion of a disaster, only men possessed the courage to risk possible death, and women’s responsibilities lay with their immediate families. The following historical photographs serve as chronicles not only of disaster but also of the growth and evolution of a profession.

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In midsummer 1888, yellow fever, a disease endemic to tropical climates and at the time associated with no known cause and an extraordinarily high mortality rate, struck Jacksonville, Florida. By September, efforts to contain “Yellow Jack,” as it was called, had failed; local relief efforts were overwhelmed, and a newly established hospital overflowed with patients.

In desperation, the hospital’s medical director turned to the service of trained nurses, an experiment in the provision of medical care that he had witnessed as a surgeon at Bellevue Hospital in New York City. Trained nurses and students immediately joined the relief efforts, bringing to the Jacksonville hospital the interventions employed at Bellevue and other northern hospitals. They systematized routines of bathing, nutrition, and hydration; they maintained a clean, cool, and well-ventilated environment; and they standardized treatment protocols in the face of massive numbers of victims. About 5,000 people were infected, and more than 400 died.

Among those who attended to Florida’s yellow fever victims were future leaders of American nursing, including Jane Delano, who would later serve as the president of the ANA and the superintendent of the Army Nurse Corps. Delano brought Lavinia Dock, who became one of the most socially conscious American nurses and a founder of the International Council of Nurses, with her. They and other nurses dramatically demonstrated in Florida and to the rest of the country the critical importance of the emerging nursing profession.

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At 4:07 pm on May 31, 1889, residents of Johnstown, Pennsylvania, heard a low rumble that grew into what was later described as “a roar like thunder.” The old and decaying South Fork Dam, containing a reservoir used for private fishing and swimming by Pittsburgh steel and coal barons, had broken. Before residents could react, 20 million tons of water and debris crashed down into the valley in what proved to be one of the worst floods in the nation’s history. Within 10 minutes, more than 2,200 people were killed and tens of thousands injured and rendered homeless.

Lavinia Dock, who had returned to her home in Pennsylvania after nursing victims of the yellow fever epidemic in Florida the preceding year, rushed with other trained nurses to the scene of the devastation. Their offers of assistance were initially received skeptically, for while trained nurses had proven their value in the contained environment of the hospital, most people still believed that women lacked the strength and the stamina necessary for disaster relief work.

But Dock and her colleagues proved them wrong. Hitching up their long skirts, they set to work tending to the victims, and their experience in public health proving invaluable. They assisted Clara Barton, the founder of the American Red Cross, and other Red Cross workers to implement more quickly the sanitary controls necessary to avert the outbreak of disease that inevitably accompanied water contamination. The work of Dock and the other nurses firmly established the place of professional nurses in disaster relief, in what seemed a triumph of the new profession.

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On September 8, 1900, a monstrous hurricane destroyed the barrier island city of Galveston, Texas, when winds of more than 125 miles per hour surged across the Gulf of Mexico and Galveston Bay through the town of 37,000 residents. The storm left 8,000 people dead and 25,000 homeless in what still ranks as the worst natural disaster in U.S. history. Clara Barton traveled to the island, on her last American Red Cross relief mission at age 78, to aid the survivors. Local legend credits her with reviving the economy of the area by introducing the new cash crop, strawberries, to the nearby inland farming community of Pasadena.

In her later writings Barton recalled the savage toll the disaster exacted from both survivors and relief workers. In Galveston, fires were kept burning for weeks to control the spread of disease caused by decaying human and animal corpses. As Barton would later write: “That peculiar smell of burning flesh, so sickening at first, became horribly familiar within the next two months, when we lived in it and breathed it, day after day.”

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The city of San Francisco was already notorious worldwide for earthquakes and fires. What would become known as the Great Earthquake struck the city at 5:13 AM, April 18, 1906, succeeded by the “seventh great fire,” which destroyed much of whatever remained standing. More than 250,000 people were left homeless and recent estimates suggest that 3,000 died in the earthquake and fires. The magnitude of the need for aid overwhelmed the combined resources of both the U.S. Army and the American Red Cross, and there simply were not enough trained nurses available to assist the ill and wounded.

The Great Earthquake resulted in significant changes in the way nurses organized disaster relief. The American Red Cross worked with the ANA to expedite a reorganization plan established the preceding year, local nursing organizations joined forces with Red Cross chapters, new standards created for nursing volunteers met professional criteria, and most important, the Red Cross created its National Committee on Red Cross Nursing Service under the leadership of Jane Delano. The Red Cross nursing service she established served the country in war, disaster, and emergency for decades afterward.

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Between the spring of 1918 and the winter of 1919, influenza roamed the globe in the most devastating epidemic in history. The parades and parties that celebrated the end of World War I in November 1918, with their crowds of tightly packed people, provided further fuel for the influenza fire. When the pandemic finally subsided in the winter of 1919, 20 million to 40 million people had succumed worldwide; in the United States, 675,000 had died. Most of its victims were between 20 and 40 years old, and the average American life span had decreased by 10 years.

Nurses played a critical role in preventing the further spread of influenza and reducing the pandemic’s severity. They taught individuals, families, and communities about respiratory hygiene, hand-washing, the disinfection of household utensils, and the critical importance of wearing gauze masks in public. And of course, they cared for those stricken. Many also found themselves enforcing a legally binding quarantine or period of isolation on often unwilling patients.

The unacknowledged heroes of the influenza pandemic were the student nurses who provided almost all of the nursing care delivered in U.S. hospitals. Most stayed by their patients’ bedsides, despite pleas from family and friends that they see to their own safety. Hundreds of them died.

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Not only was it one of the most violent racial confrontations in American history, the Tulsa Race Riot of 1921 has also been one of the least recognized. Even many native Oklahomans didn’t know it had happened until very recently.

On May 31, 1921, an African American man, Dick Rowland, was arrested for allegedly assaulting a white elevator operator, Sarah Page. Although no copies of that evening’s Tulsa Tribune have survived, it has been widely reported that the front page bore a headline that read “Nab Negro for Attacking Girl in Elevator”; its back page is said to have carried an editorial titled “To Lynch Negro Tonight.”

That night, thousands of white men, women, and children surrounded the Tulsa courthouse. Violence erupted when a group of 75 African American men marched to the courthouse to protect Rowland; gunshots were exchanged, leaving several whites and blacks dead. Enraged whites stormed the African American neighborhood of Greenwood City, shooting, looting, and burning homes; an estimated 300 people died and hundreds were wounded. The governor declared martial law, the National Guard was deployed, all blacks were detained, and all of Greenwood City was destroyed. (See Maurice Willow coordinated the relief efforts in Tulsa, along with a group of nurses and physicians. They set up emergency hospitals and helped the many African Americans left homeless.

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On the evening of November 28, 1942, a busboy at Boston’s popular Cocoanut Grove Nightclub struck a match, accidentally igniting some decorative bunting. Within seconds the entire club was engulfed in flames, and 492 of the 1,000 people in attendance died, many of them trapped at locked exits. As many were injured in what was then the worst fire in U.S. history.

Boston’s hospitals were inundated not only with the critically burned but also with distraught friends and families. Critical care nurses credit the immediate aftermath of the Cocoanut Grove fire as a turning point in the development of their specialty. The high number of burn victims tested not only their triage skills but also their ability to maintain fluid volumes, manage shock, assess skin integrity and structural alignments, and ensure pain relief.

In the pandemonium of the fire’s aftermath, nurses and physicians also discovered the power of attending to emotional as well as physical needs. Eric Lindeman’s seminal work with the survivors of the fire and bereaved family members directed subsequent understanding of normal grief reactions. Less well known is the fact that nurses learned to care for the caregivers, as well. Stories abound of nurses and others working for hours in Boston’s EDs, then seeking temporary respite in the less draining tasks to be done in hospital laundries and kitchens.

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On April 19, 1995, at 9:03 am, a car bomb ripped through the Alfred P. Murrah Federal Building in Oklahoma City. The bomb caused the collapse of the entire front portion of the nine-story building, killing 167 people and injuring hundreds of others. Rescue workers rushed to the scene of what was at that time the worst terrorist attack on U.S. soil.

Nurses throughout the area responded by doing what they do best—treating and caring for the injured and counseling and supporting those who lost loved ones. Nurse volunteers worked at shelters set up for families of victims and those displaced by the bombing. Nurses immunized rescue workers, made sure those affected were taking required medications, and supplied families with simple necessities such as food and blankets.

Rebecca Needham Anderson, a local LPN and mother of four, was on her day off when she heard the news of the bombing. Knowing there were children killed or injured in the disaster, Anderson rushed to the scene to help with the recovery effort. While tending to the wounded, she sustained a serious head injury from falling debris. Five days later she became the 168th fatality of the Oklahoma City bombing. (For a related article, see In Our Community, “American Red Cross Nursing: Essential to Disaster Relief,” August.)

© 2004 Lippincott Williams & Wilkins, Inc.