Sandra Richardson

The initial health-system response to the earthquake in Christchurch, New Zealand, in February, 2011

At 1251 h on Feb 22, 2011, an earthquake struck Christchurch, New Zealand, causing widespread destruction. The only regional acute hospital was compromised but was able to continue to provide care, supported by other hospitals and primary care facilities in the city. 6659 people were injured and 182 died in the initial 24 h. The massive peak ground accelerations, the time of the day, and the collapse of major buildings contributed to injuries, but the proximity of the hospital to the central business district, which was the most affected, and the provision of good medical care based on careful preparation helped reduce mortality and the burden of injury. Lessons learned from the health response to this earthquake include the need for emergency departments to prepare for: patients arriving by unusual means without prehospital care, manual registration and tracking of patients, patient reluctance to come into hospital buildings, complete loss of electrical power, management of the many willing helpers, alternative communication methods, control of the media, and teamwork with clear leadership. Additionally, atypical providers of acute injury care need to be integrated into response plans.

Toxicity from the recreational use of 1-benzylpiperazine.

Aim. This study describes the demographics and symptoms of patients, who presented to the Emergency Department (ED) in Christchurch, New Zealand, with toxicity from 1-benzylpiperazine (BZP)-based “party pills.” BZP use has become widespread among the 16- to 30-year age group in New Zealand. This study explores the relationship between plasma BZP level and adverse effects experienced by users. The influence of ethanol co-ingestion was also studied. Methods. From 1 April 2005 to 1 July 2007, all BZP-related presentations to the ED were captured on a prospective data sheet. Patients were recruited to obtain plasma BZP levels, and these were correlated with the incidence of seizures and other symptoms. Coexistent ethanol use was also correlated with the frequency of seizures and other common BZP-induced symptoms. Results. In total 178 presentations with BZP toxicity were recorded. BZP levels were measured in 96. Sixty-nine percent of patients co-ingested other substances, with the most common substance being ethanol. In patients who ingested BZP alone, increased plasma BZP levels were associated with increased seizure frequency. Ethanol co-ingestion reduced the incidence of seizures, but significantly increased the likelihood of confusion and agitation. Conclusions. Adverse effects from BZP commonly include confusion, agitation, vomiting, anxiety, and palpitations. There is strong evidence that higher plasma levels of BZP are associated with an increased incidence of seizures. Co-ingestion of ethanol increases the likelihood of common and distressing BZP-induced symptoms but reduces the incidence of BZP seizures.

Child home injury prevention: understanding the context of unintentional injuries to preschool children

Injury to young children at home is a public health problem. In New Zealand, over half the injury deaths and hospitalisations among 0–4 year olds occur at home. Causes and risk factors for child injury have been identified, but their circumstances are not well described. Understanding the context, however, is important for developing and implementing effective prevention. To obtain the descriptions of injury events, semi-structured interviews were conducted with a convenience sample of 100 caregivers of 0–4 year olds attending an emergency department for a home injury. Analysis from this exploratory study indicated that most events occurred within usual family activity, but had multiple factors interacting. Injury was rarely the expected outcome. Findings concurred with findings from others’ research that reported home injury to be complex and multifaceted. Factors related to the environment, the child, the parent, their behaviours and activity interacted, with common patterns preceding injury being evident such as times of day and disrupted routines. Factors were often found to occur regardless of the cause of injury. Complex parental factors were identified, such as not anticipating risk, having unrealistic expectations of children, lacking knowledge of child development and accepting injury as a norm. Directions for further research are identified.

Innovations and lessons learned from the Canterbury earthquakes : Emergency department staff narratives

Purpose – The purpose of this paper is to identify innovations and lessons learned from interviews with members of the multidisciplinary healthcare team who participated in the response to the 22 February earthquake, affecting the Canterbury region of New Zealands South Island. Design/methodology/approach – Narratives from individual staff members who were associated with the Christchurch Hospital Emergency Department response were recorded and analysed. This data, together with other contextual documents have been used to identify the responses of healthcare workers to an unexpected natural disaster. Perspectives were sought from a range of individuals, including allied health professionals, social workers, Maori health workers, orderlies, medical and nursing staff. Findings – The individual as well as the organisational responses to the earthquake events are significant, and need to be considered in relation to future planning and responses. In particular, the importance of encouraging and supporting a...

Increasing patient numbers: The implications for New Zealand emergency departments

Within the New Zealand (NZ) health care system, a number of changes have affected the way health care is accessed and delivered. Emergency Departments (EDs) are noticing increased attendance of patients with minor or non-urgent conditions. This increase in patient volume, together with on-going fiscal constraints and restructuring, has placed an added strain on the functioning of EDs. New Zealand nurses need to question the role currently given to EDs and identify the issues surrounding the increased use of these departments for primary health care. Is this move feasible in the NZ environment, and what are the implications for emergency nurses?

Earthquake disaster response in christchurch, New Zealand.

On September 4, 2010, an earthquake that measured 7.1 on the Richter scale struck the region of Canterbury, New Zealand. Even though it was the same magnitude as the Haitian earthquake in January 2010 that killed more than 220,000 people, not one person lost his or her life in the city of Christchurch. Human survival was due to 3 interrelated elements: rigorously applied building codes, the earthquake’s depth of 6 miles (10 km) and distance of 25 miles (38 km) from Christchurch, and the early morning time of the occurrence (4:35 AM). Although damage was significant, many of Christchurch’s major landmarks survived, and during the following months, locals began to tell with unerring accuracy the magnitudes of the thousands of aftershocks that are normal after these events. What came a few months later was a whole different situation. Tuesday, February 22, 2011, started out as an ordinary day in many ways in Christchurch. The continuing aftershocks were subsiding in both frequency and intensity, and although a number of buildings had been damaged or even destroyed by the earlier earthquake, most people were simply getting on with their day in hospitals, schools, offices, and homes. In the Christchurch Hospital Emergency Department—one of the busiest emergency departments in the southern hemisphere, where more than 87,000 patients are seen each year— the day also started quite ordinarily. This emergency department is almost unique in the developed world, because it is the only emergency department in a city of 400,000; the next nearest emergency department is a 4-hour drive away. When a magnitude 6.3 earthquake struck at 12:51 PM, staff struggled to stay on their feet as the lights went out. The emergency generators were challenged to maintain a supply of electricity and failed over the course of the following hours as dozens of aftershocks struck (Figure 1).

The impact of a natural disaster: under- and postgraduate nursing education following the Canterbury, New Zealand, earthquake experiences

While natural disasters have been reported internationally in relation to the injury burden, role of rescuers and responders, there is little known about the impact on education in adult professional populations. A 7.1 magnitude earthquake affected the Canterbury region of New Zealand on 4 September 2010 followed by more than 13,000 aftershocks in the three years to September 2013. As part of a larger study, a mixed method survey was used to explore factors impacting nurses engaged in education through polytechnic and university courses. This paper presents factors that were self-identified by students as supporting their ability to continue with education. Participants were recruited from three nursing settings: undergraduate nursing students, Registered Nurses (RNs) engaged in post-registration education and RNs engaged in postgraduate courses. A total of 290 participants took part in the study. A number of factors identified by participants could be addressed in pre-disaster course planning and curriculum design; through education and support of both students and staff; and the active promotion of personal, professional and institutional resilience.

Expressions of cultural safety in public health nursing practice

Cultural safety is an essential concept within New Zealand nursing that is formally linked to registration and competency-based practice certification. Despite its centrality to New Zealand nursing philosophies and the stated expectation of cultural safety as a practice element, there is limited evidence of its application in the literature. This research presents insight into public health nurses (PHN) experiences, demonstrating the integration of cultural safety principles into practice. These findings emerged following secondary analysis of data from a collaborative, educative research project where PHNs explored the use of family assessment tools. In particular, the 15-minute interview tool was introduced and used by the PHNs when working with families. Critical analysis of transcribed data from PHN interviews, utilising a cultural safety lens, illuminated practical ways in which cultural safety concepts infused PHN practice with families. The themes that emerged reflected the interweaving of the principles of cultural safety with the application of the five components of the 15-minute interview. This highlights elements of PHN work with individuals and families not previously acknowledged. Examples of culturally safe nursing practice resonated throughout the PHN conversations as they grappled with the increasing complexity of working with a diverse range of families.

A Sex Disparity Among Earthquake Victims.

OBJECTIVE Understanding who is most vulnerable during an earthquake will help health care responders prepare for future disasters. We analyzed the demography of casualties from the Christchurch earthquake in New Zealand. METHODS The demography of the total deceased, injured, and hospitalized casualties of the Christchurch earthquake was compared with that of the greater Christchurch population, the Christchurch central business district working population, and patients who presented to the single acute emergency department on the same month and day over the prior 10 years. Sex data were compared to scene of injury, context of injury, clinical characteristics of injury, and injury severity scores. RESULTS Significantly more females than males were injured or killed in the entire population of casualties (P20% were injured at commercial or service localities (444/2032 males [22%]; 1105/4627 females [24%]). Adults aged between 20 and 69 years (1639/2032 males [81%]; 3717/4627 females [80%]) were most frequently injured. CONCLUSION Where people were and what they were doing at the time of the earthquake influenced their risk of injury.

Psychological health and resilience: the impact of significant earthquake events on tertiary level professional students. A cross-sectional study

Background: The effect of natural disasters internationally is linked to intensity and duration and the impact of these events for tertiary level professional students is not clearly understood. Following a 7.1 magnitude earthquake in New Zealand in 2010 (with aftershocks lasting 27 months) a number of tertiary nursing students experienced significant disruption to their studies. Aim: To compare the psychological health, resilience and the impact on learning for three cohorts of students engaged in tertiary nursing education during this time. Method: A cross-sectional survey design and convenience sampling was used for three cohorts of learners. An online survey was completed (n = 290) and included: Depression Anxiety and Stress Scale; PTSD Checklist; Work and Social Adjustment Scale; Connor-Davidson Resilience Scale. Results: Statistically significant differences were found across the psychometric scales with regard to relationship status. Whilst an increase in self-reported physical and mental health issues prior to and following the earthquakes were noted, mitigating factors were also identified. Conclusions: In order to support psychological health amongst nursing students, tertiary education systems need to plan for sustainable learning. The importance of facilitating future orientation within organisations is necessary to develop resilience amongst staff and students, which, in turn, will enable on-going education during significant disaster events.