- Email: [email protected]
Humanitarian Aid Simulation
Clinical Simulation in Nursing (2012) 9, e607-e608
www.elsevier.com/locate/ecsn
Featured Article
Humanitarian Aid Simulation Lena Choudhary, JD, MS, RN* Anne Arundel Community College, 101 College Parkway, Arnold, MD 21012-1895, USA
When health care providers rushed to assist after the September 11 attacks, they were neither prepared nor cognizant of the risk of serious respiratory ailments or blood cancer they were exposed to. When community members and nurses traveled to Haiti after the 2010 earthquake, many were not prepared for life in a makeshift camp without potable water and the risk of dengue fever. In the aftermath of hurricane Katrina in 2005, emergency staff brought in from around the country were not adequately prepared to deal with anger over racial inequity. As health care and emergency workers, we have a strong commitment to helping when the need arises, and often we are put into the position of not only providing care but also managing or organizing the large numbers of volunteers, government institutions, and community members who also desire to help. We may have the experience or education to triage patients or to provide emergency care for the injured, but we may not have the skills to organize a camp of 50 workers or to negotiate with the military or paramilitary to give us access to the injured in the field. We may not have the background that allows us to understand the negotiation, compromise, and mediation skills necessary to convince a warden to allow us access to prisoners in order to evaluate living conditions. We often are under prepared to ensure our own safety. We are more concerned with aiding the injured than with adequately protecting our own health. There is a clear need for training through simulation. Humanitarian organizations provide health care, supplies, and training in zones of conflict around the world. This work is necessary but not without risks. If they are not managed and trained appropriately, aid organizations can cause more disruption, more conflict, and more injuries to the aid workers or the communities they serve. In an environment that includes rebel forces and corrupt
* Corresponding author: [email protected] (L. Choudhary).
government entities, how will the local community be convinced of the workers’ benign interests? When you have been allowed entry by a corrupt government and your camp is protected by a corrupt military, how will community members come to believe that your organization has no hidden motives in supplying food or medical supplies? When you are dealing with mass casualties, how do you make sure you are not caught in cross-fire and become an addition to the casualty count? What do you do when your camp supplies are low and famine victims come to camp, looking for food? Simulation once again provides an opportunity to gain experience in an environment that is controlled and safe, with minimal risks. Atlantic Hope was created at Indian River State College to provide students interested in working for the International Committee for the Red Cross or the Peace Corps, in mission work, or with any other humanitarian aid effort an opportunity to learn how to run a camp of 50 aid workers. This 4-day intensive simulation attempts to recreate the experience of entering a distrusting and militaristic country. The students are badgered by lowlevel bureaucrats on their way through customs. They are briefed by the aid organization’s country representative. They are given information on maintaining safety, on maintaining lines of communication, and on the administration and structure of a camp. The students are then ‘‘flown’’ into the country’s interior to set up their camp. They are escorted into camp by the local militia brandishing machine guns. They are responsible for raising tents, creating a security perimeter and a communication system, feeding, and maintaining the hygiene of the camp. Negotiation begins when the country’s military detail sent to maintain the students’ safety begins to infringe on their work. Students live in camp for 3 nights, without access to showers; they share one bathroom, and they eat meager meals of basics such as rice and beans, similar to conditions in humanitarian aid efforts.
1876-1399/$ - see front matter Ó 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ecns.2012.09.007
Humanitarian Aid Simulation
e608
Throughout the program groups are called on to address mass casualties while ‘‘bullets’’ fly above their heads. Locals come begging for food, which leaves students in ethical dilemmas as to what to share if they are not sure they have enough for the staff. Students negotiate with guerrillas to get access to injured hostages. Students attempt to get access to prisoners, write reports to the Red Cross, or transfer information to family members concerned for loved ones. One of the interesting lessons learned is the priority or triage flow in the field. In cardiopulmonary resuscitation, health care providers are taught to treat most emergencies as possible heart attacks, so getting the automated external defibrillator is the top priority. In conflict zones, the priority is getting the injured out of the conflict and stopping the loss of blood until the patient can be taken to a hospital or medical unitda completely different set of priorities and a different way of thinking. Another phenomenon the students encounter is how to handle living in stressful conditions due to the violence in the area and the lack of basic comforts. In addition, students must take on leadership roles, taking turns managing and leading the camp and trying to smooth over the tensions and personal crises that these environments can elicit. Students are confronted with the conflicting demands of the needy population they came to aid and the basic needs for water, food, and rest necessary to keep themselves (in their role as aid workers) safe, healthy, and in good spirits. The response to the simulation from the faculty and the students has been overwhelmingly positive. Students from all disciplines participate. International relations and political science majors make up the majority of participants. Homeland security, nursing, and other health care disciplines participate. Students are recruited to be moulaged as
injured patients or to provide basic first aid and safe transport training during the briefing period. This is experiential learning at its best. Many students return year after year, first as participants and later as leaders of the newbies. Many have gone on to apply to Fulbright, AmeriCorps, and the Peace Corps. Faculty leave excited and energized to further prepare students in following years by incorporating FEMA’s Community Emergency Response Team training components in preparation for the simulation. Faculty recruit colleagues to participate, and the student groups keep growing in numbers. Faculty come together before, during, and after the simulation to evaluate the program and incorporate new ideas each year. Health care simulations often provide experiences for students to test themselves and learn how to manage a patient who experiences cardiac arrest or respiratory distress. Little education is provided to train students how to protect their own health and welfare. Simulations such as Atlantic Hope raise awareness about the necessity to keep oneself safe before running to help another. In Cardio Pulmonary Arrest training and Community Emergency Response Training, the first action is to determine ‘‘scene safety.’’ Atlantic Hope raises awareness of the need for personal safety first no matter what the environment. Educational institutions have made the global perspective a priority in their strategic planning. Curricula is rift with topics covering cultural awareness, self- awareness and ethnic diversity. In addition, students are participating in service learning in record numbers. Preparing and educating these groups psychologically, emotionally, and physically before they find themselves in challenging circumstances is critical to their success. Atlantic Hope is a fine example of how this goal can be reached.
pp e607-e608 Clinical Simulation in Nursing Volume 9 Issue 12
www.elsevier.com/locate/ecsn
Featured Article
Humanitarian Aid Simulation Lena Choudhary, JD, MS, RN* Anne Arundel Community College, 101 College Parkway, Arnold, MD 21012-1895, USA
When health care providers rushed to assist after the September 11 attacks, they were neither prepared nor cognizant of the risk of serious respiratory ailments or blood cancer they were exposed to. When community members and nurses traveled to Haiti after the 2010 earthquake, many were not prepared for life in a makeshift camp without potable water and the risk of dengue fever. In the aftermath of hurricane Katrina in 2005, emergency staff brought in from around the country were not adequately prepared to deal with anger over racial inequity. As health care and emergency workers, we have a strong commitment to helping when the need arises, and often we are put into the position of not only providing care but also managing or organizing the large numbers of volunteers, government institutions, and community members who also desire to help. We may have the experience or education to triage patients or to provide emergency care for the injured, but we may not have the skills to organize a camp of 50 workers or to negotiate with the military or paramilitary to give us access to the injured in the field. We may not have the background that allows us to understand the negotiation, compromise, and mediation skills necessary to convince a warden to allow us access to prisoners in order to evaluate living conditions. We often are under prepared to ensure our own safety. We are more concerned with aiding the injured than with adequately protecting our own health. There is a clear need for training through simulation. Humanitarian organizations provide health care, supplies, and training in zones of conflict around the world. This work is necessary but not without risks. If they are not managed and trained appropriately, aid organizations can cause more disruption, more conflict, and more injuries to the aid workers or the communities they serve. In an environment that includes rebel forces and corrupt
* Corresponding author: [email protected] (L. Choudhary).
government entities, how will the local community be convinced of the workers’ benign interests? When you have been allowed entry by a corrupt government and your camp is protected by a corrupt military, how will community members come to believe that your organization has no hidden motives in supplying food or medical supplies? When you are dealing with mass casualties, how do you make sure you are not caught in cross-fire and become an addition to the casualty count? What do you do when your camp supplies are low and famine victims come to camp, looking for food? Simulation once again provides an opportunity to gain experience in an environment that is controlled and safe, with minimal risks. Atlantic Hope was created at Indian River State College to provide students interested in working for the International Committee for the Red Cross or the Peace Corps, in mission work, or with any other humanitarian aid effort an opportunity to learn how to run a camp of 50 aid workers. This 4-day intensive simulation attempts to recreate the experience of entering a distrusting and militaristic country. The students are badgered by lowlevel bureaucrats on their way through customs. They are briefed by the aid organization’s country representative. They are given information on maintaining safety, on maintaining lines of communication, and on the administration and structure of a camp. The students are then ‘‘flown’’ into the country’s interior to set up their camp. They are escorted into camp by the local militia brandishing machine guns. They are responsible for raising tents, creating a security perimeter and a communication system, feeding, and maintaining the hygiene of the camp. Negotiation begins when the country’s military detail sent to maintain the students’ safety begins to infringe on their work. Students live in camp for 3 nights, without access to showers; they share one bathroom, and they eat meager meals of basics such as rice and beans, similar to conditions in humanitarian aid efforts.
1876-1399/$ - see front matter Ó 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ecns.2012.09.007
Humanitarian Aid Simulation
e608
Throughout the program groups are called on to address mass casualties while ‘‘bullets’’ fly above their heads. Locals come begging for food, which leaves students in ethical dilemmas as to what to share if they are not sure they have enough for the staff. Students negotiate with guerrillas to get access to injured hostages. Students attempt to get access to prisoners, write reports to the Red Cross, or transfer information to family members concerned for loved ones. One of the interesting lessons learned is the priority or triage flow in the field. In cardiopulmonary resuscitation, health care providers are taught to treat most emergencies as possible heart attacks, so getting the automated external defibrillator is the top priority. In conflict zones, the priority is getting the injured out of the conflict and stopping the loss of blood until the patient can be taken to a hospital or medical unitda completely different set of priorities and a different way of thinking. Another phenomenon the students encounter is how to handle living in stressful conditions due to the violence in the area and the lack of basic comforts. In addition, students must take on leadership roles, taking turns managing and leading the camp and trying to smooth over the tensions and personal crises that these environments can elicit. Students are confronted with the conflicting demands of the needy population they came to aid and the basic needs for water, food, and rest necessary to keep themselves (in their role as aid workers) safe, healthy, and in good spirits. The response to the simulation from the faculty and the students has been overwhelmingly positive. Students from all disciplines participate. International relations and political science majors make up the majority of participants. Homeland security, nursing, and other health care disciplines participate. Students are recruited to be moulaged as
injured patients or to provide basic first aid and safe transport training during the briefing period. This is experiential learning at its best. Many students return year after year, first as participants and later as leaders of the newbies. Many have gone on to apply to Fulbright, AmeriCorps, and the Peace Corps. Faculty leave excited and energized to further prepare students in following years by incorporating FEMA’s Community Emergency Response Team training components in preparation for the simulation. Faculty recruit colleagues to participate, and the student groups keep growing in numbers. Faculty come together before, during, and after the simulation to evaluate the program and incorporate new ideas each year. Health care simulations often provide experiences for students to test themselves and learn how to manage a patient who experiences cardiac arrest or respiratory distress. Little education is provided to train students how to protect their own health and welfare. Simulations such as Atlantic Hope raise awareness about the necessity to keep oneself safe before running to help another. In Cardio Pulmonary Arrest training and Community Emergency Response Training, the first action is to determine ‘‘scene safety.’’ Atlantic Hope raises awareness of the need for personal safety first no matter what the environment. Educational institutions have made the global perspective a priority in their strategic planning. Curricula is rift with topics covering cultural awareness, self- awareness and ethnic diversity. In addition, students are participating in service learning in record numbers. Preparing and educating these groups psychologically, emotionally, and physically before they find themselves in challenging circumstances is critical to their success. Atlantic Hope is a fine example of how this goal can be reached.
pp e607-e608 Clinical Simulation in Nursing Volume 9 Issue 12