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American Red Cross Nursing:Essential to Disaster ReliefYou don’t have to be an ‘angel on the battlefield’ to serve.

More than 40,000 nurses currently serve inthe American Red Cross in paid or volun-teer capacities, as members of disaster

action teams (DATs); blood drive workers; healthand safety educators; board members; task forcespecialists; researchers; and representatives on local,state, regional, and national Red Cross committees.1

These nurses represent a small fraction of those whocould potentially become involved at some level.(There were approximately 2,246,000 RNs and683,000 LPNs employed in this country in 2003.2)

Since September 11, 2001, AJN has publishedseveral articles describing how nurses can better pre-pare themselves to respond to acts of terrorism. Justtwo have mentioned the Red Cross and its role indisaster relief. Kennedy and colleagues suggestedthat nurses consider participating in Red CrossDATs,3 which mobilize within minutes or hours of adisaster. The article noted that such participationinvolves taking several Red Cross courses, includingstandard first aid, disaster response, damage assess-ment, family services, shelter operations, mass care,and mental health counseling. Not mentioned, butparticularly pertinent for nurses because they alreadypossess many of the requisite skills, are the two dis-aster health services courses. A nurse may take justthe Introduction to Disaster course, which makes hereligible to serve during local disasters, and can decidelater whether to take additional courses.

Gebbie and Qureshi described core competenciesthat nurses need for emergency and disaster pre-paredness, and listed several agencies that provideinformation and resources.4 The Red Cross wasmentioned only as a resource for information on

developing a family emergency plan. But in mostdisasters, the Red Cross assumes primary responsi-bility for providing food, clothing, and shelter forboth victims and volunteer relief workers. The onlynongovernmental organization mentioned in theFederal Response Plan, it’s designated as the leadagency responsible for “Mass Care” (EmergencySupport Function #6) and as a support agencyresponsible for “Information and Planning,”“Health Services,” and “Food” (Emergency SupportFunctions #5, #11, and #8, respectively).5 Red Crossnurse volunteers are essential to fulfilling thesefunctions.

Like other health care organizations, the RedCross has felt the impact of the nursing shortage.Nurses are needed to help with relief efforts in thewake of natural and manmade disasters, includinghurricanes, floods, forest fires, and earthquakes; andthe current “war on terrorism” has increased thedemand for nurses with appropriate response skillsin all settings. Every nurse should consider obtainingat least the training needed to volunteer at the locallevel. Nurses who could be available to travel to adisaster site should consider enrolling in the Red

Cheryl K. Schmidt is a lieutenant colonel (retired) in the U.S. ArmyReserve Nurse Corps and an associate professor in the College ofNursing at the University of Arkansas for Medical Sciences, LittleRock, and the 2004 recipient of the American Red Cross’s AnnMagnussen Award for nursing. For assistance in developing this manu-script, the author acknowledges Roger Elliot, state disaster director, andAlan Gibson, community development director, American Red Cross ofGreater Arkansas; Deborah Carman, MNSc, RN, national chairpersonof preparedness, American Red Cross, and member, American RedCross National Biomedical Committee; Victoria Childs, BSN, RN, pro-gram specialist, Recovery Division, Federal Emergency ManagementAgency, Department of Homeland Security; Nancy McKelvey, MSN,RN, chief nurse, American Red Cross; and Jean Waldman, RN, volun-teer nurse historian, American Red Cross. In Our Community is coordi-nated by Elizabeth Anderson, DrPH, RN, FAAN: etanders@utmb.edu.

By Cheryl K. Schmidt, PhD, RN, ANC

Falling trees can be a major life-threatening hazard during a tornado, such as the onethat struckthis house in Carbon Hill, Alabama.

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One Vision Followed by ThousandsClara Barton turned caring into global call to action.

Nurses have been integral to the success of theAmerican Red Cross since Clara Barton estab-

lished the organization in 1881. Barton, who nevermarried, disliked and resisted proudly the limita-tions placed on women in her day, as her book,The Red Cross in Peace and War, explains.

Born in 1821 and raised on a farm in NorthOxford, Massachusetts, she learned how to handleguns and horses. She became a teacher while stillin her teens and in 1852 established a free publicschool in Bordentown, New Jersey. In 1854 shemoved to Washington City (now Washington, D.C.)and became a copy clerk for the U.S. PatentOffice, the only government agency in Washingtonthat hired women.

When the Civil War began in 1861, she wasdistressed to learn that the Union Army had madealmost no medical preparations. The wounded anddead lay exposed on the battlefields while ware-houses, churches, and schools were hastily con-verted into temporary hospitals. Barton turned herattention to helping the soldiers encamped inWashington City. Although she had no formal train-ing in nursing, as a child she had cared daily foran older brother during his serious illness and longconvalescence.

In 1861 the Union Army appointed one ofBarton’s contemporaries, Dorothea Dix, as superin-tendent of women nurses. But female nurses in themilitary weren’t permitted to serve on the battlefield,and Barton didn’t join. Instead she rallied womenthroughout Massachusetts to collect food, clothing,

whiskey, and medical supplies, delivering themdirectly to soldiers on the battlefield. She began pro-viding basic nursing care as well, to the soldiers ofboth armies, and her reputation as an independentbattlefield nurse grew. One surgeon who served atthe Battle of Antietam described her as “the trueheroine of the age, the angel of the battlefield.”1

But by 1864 the military bureaucracy had grownlarger and more powerful, and independent reliefworkers like Barton found their services were nolonger encouraged. She started helping to locateand label the graves of the nearly 13,000 Unionsoldiers who had died at the prison camp inAndersonville, Georgia, which would eventually bedeclared a national cemetery.

The International Red Cross was started in 1863by a Swiss citizen, Henry Dunant, who’d witnessedthe suffering caused by war during the War ofItalian Unification, and four others. It called for thefirst Geneva Convention, an international meetingaimed at finding ways to make war “morehumane.” Twelve governments signed the originaltreaty,2 which Barton described as providing forthe “neutrality of all sanitary supplies, ambulances,surgeons, nurses, attendants, and sick or woundedmen, and their safe conduct when they bear thesign of the organization, the Red Cross.”3 Otherssoon followed, with each nation founding its ownindependent Red Cross.

Although it had sent two delegates to the GenevaConvention, the United States did not initially signthe treaty. Barton was instrumental in achieving this,though it took years. In 1869 she went to Europe torecover from typhoid fever; while there she learnedabout the International Red Cross. On her returnhome in 1873, she mounted a prolonged campaignto get the United States to sign the treaty, and shelobbied President Rutherford B. Hayes for supportfor an American Red Cross. It took years, but in1881 the American Association of the Red Crosswas formed (today its official name is the AmericanNational Red Cross) and, at age 60 Clara Bartonvolunteered to serve as its first president. In 1882,after a visit from Barton herself, U.S. PresidentChester Arthur signed the Geneva Treaty. (Editor’snote: in this article and in the accompanying mainarticle, unless otherwise specified, “Red Cross”refers to the American organization.)

During peacetime, schools were established byseveral European Red Cross organizations to edu-cate women in caring for the sick and wounded onthe battlefield and in hospitals. These nurses were

A 1934 photograph with a caption that read: “A RedCross Public Health Nurse is recognized by her uniform and Red Cross symbol as a firm friend in timeof illness or home emergency.”

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Cross’s Disaster Services Human Resources (DSHR)system. Potential enrollees indicate whether theyhave the training and skills needed to respond to avariety of disasters; those who do have their creden-tials are cleared in advance. When the Red Crossneeds nurses with specialized skills, this informationcan be accessed through the DSHR system and thenurses can be assigned quickly to disaster sites any-where in the United States. Nurses who are able andwilling to travel outside of the United States can par-ticipate through the International Red Cross.

In the past, nurses lacking disaster training haveoften spontaneously volunteered their services dur-ing disasters. Though well intentioned, they havecontributed to the chaos, as some who have had toorganize large numbers of volunteers have attested;a few nurses have even been injured or killedbecause they failed to assess the safety of the disas-ter scene. These assessment skills are taught in thestandard first-aid course required of all Red CrossDisaster Services volunteers.

Some nurses will already be committed to theirown agencies during disasters, but that doesn’t nec-essarily preclude participation in Red Cross reliefefforts. And nurses may be able to serve their ownagencies and their communities better if they’vetaken Red Cross disaster courses. For example,nurses who are military reservists or NationalGuardsmen can serve as Red Cross volunteers iftheir units aren’t mobilized. Retired nurses, educa-tors, and part-time or unemployed nurses can serve.The DSHR system also accommodates volunteerswith disabilities to function actively on DSHRassignments, depending on the type and severity ofthe disability.

My involvement in the Red Cross has given me avariety of community service opportunities. As achild, I had often watched my mother don her whiteuniform, cap, and Red Cross pin as she prepared tovolunteer at local blood drives. I soon followed herlead, assisting with blood drives in 1969 while stilla student nurse and, beginning in 1974, teachingfirst aid and cardiopulmonary resuscitation to nurs-ing students and members of the communities I’velived in.

In June 1999, I became involved in disaster serv-ices when I learned that nurses were needed torespond to the crash of American Airlines flight1420 in Little Rock. The plane had been attemptinga landing in high winds with 145 people aboardwhen it skidded off the airport runway and caughtfire, killing 11 and injuring 80. Because I had beenan Army Nurse Corps reservist for 20 years andknew how to care for patients in field environments,I was assigned to the care of civilian and govern-ment personnel working at the crash site. I moni-tored them for heat-related injuries (a real risk in thehot, humid Arkansas climate) and provided first aid

released from their civilian positions to serve dur-ing times of war. In 1893 the first and onlyAmerican Red Cross school of nursing, the NewYork Red Cross Hospital and Training School forRed Cross Sisters was opened.4 (The first generaltraining program for nurses in this country wasinstituted at the New England Hospital forWomen and Children, which opened in 1872.)Most Red Cross nurses trained for their professionin civilian hospitals, then volunteered to becomeRed Cross nurses, as they do today. Red Crossnurses served in military camps and hospitals dur-ing the Spanish–American War in 1898; theyalso cared for victims of the yellow fever epidemicand of natural disasters.

Twelve governments signed the original treaty.During World War I, more than 29,000American Red Cross nurses served as civilian vol-unteers with the Army or the Navy Nurse Corpsat home and overseas. Many eventually decidedto join one of these corps, and as the number ofregular military nurses increased, the need forRed Cross nurses in war-zone hospitals dimin-ished. The Red Cross continued to provide nurses’aides, and during World War II the Civil ServiceCommission hired these aides to supplement nurs-ing staff in military hospitals.

The Red Cross has continued recruiting andpreparing nurses as unofficial reservists for serv-ice during wars or other emergencies eversince.5—Cheryl K. Schmidt, PhD, RN, ANC

REFERENCES1.Oates S. A woman of valor: Clara Barton and the Civil War.

New York City: The Free Press; 1994: 91. 2. Laws of war: amelioration of the condition of the wounded on

the field of battle; August 22, 1864. 1998. http://www.yale.edu/lawweb/avalon/lawofwar/geneva04.htm.

3.Barton C. The Red Cross in peace and war. Washington, DC:American National Red Cross; 1898: 24.

4.Kernodle P. The Red Cross nurse in action. New York City:Harper & Brothers; 1949: 12-3.

5.Kalisch P, Kalisch B. The advance of American nursing.Philadelphia: Lippincott Williams and Wilkins; 1995.

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Clara Barton, whoserved as the first president of theAmericanNational RedCross, in 1906.

the scene before acting, so they don’t become vic-tims themselves.

At the University of Arkansas for MedicalSciences, where I teach community nursing, I incor-porate disaster relief into clinical coursework when-ever possible. For instance, when the 1999tornadoes struck Arkansas, my students and Ihelped staff a Federal Emergency ManagementAgency warehouse and organized the dispensationof donated food and clothing to displaced familiesand relief workers. Nursing students can also gainclinical experience by teaching Red Cross health orsafety courses. In my experience, students whobecome involved in the Red Cross tend to continuethat involvement after graduation.

In 2002 I chaired a statewide coalition of nursingassociations and organizations, including the CentralArkansas Chapter of the American Red Cross,aimed at preparing nurses throughout Arkansas torespond to bioterrorism. We developed a course onbioterrorism recognition and response that wasapproved by the Arkansas Nurses Association forcontinuing education credit and presented to nursesstatewide. In July 2002 I and other Red Cross lead-ers from across the nation participated in a“Weapons of Mass Destruction–Terrorism Work-shop” at the Clara Barton Center in Pine Bluff, Ar-kansas. The center was established to provideresponse training in collaboration with the Office ofHomeland Defense and the United States military. Iwas also the only nurse appointed to the ArkansasDepartment of Health Bioterrorism AdvisoryCommittee that year. I continue to travel statewideproviding education about bioterrorism and otherpublic health emergencies, and I always includeinformation about the American Red Cross.

The Arkansas Nurses Association has formed apartnership with the Red Cross chapters inArkansas to provide continuing education credit fornurses who enroll in Red Cross disaster courses. Iencourage all nurses to register as Red Cross volun-teers in their communities and to obtain disastertraining. For more information, see www.redcross.org/services/nursing. ▼

REFERENCES 1.American National Red Cross. Nursing. 2004. http://www.

redcross.org/services/nursing/0,1082,0_327_,00.html. 2.Bureau of Labor Statistics. Occupational Employment and

Wages, May 2003. 2003. http://www.bls.gov/oes/2003/may/oes291111.htm.

3.Kennedy S, et al. Disaster education and training are sorelyneeded. Am J Nurs 2001;101(11):18-9.

4.Gebbie KM, Qureshi K. Emergency and disaster prepared-ness: core competencies for nurses. Am J Nurs 2002;102(1):46-51.

5.American National Red Cross. American Red Cross respon-sibilities under the Federal Response Plan. 2001.http://www.tallytown.com/redcross/dsp/form3013.pdf.

as the need arose during the cleanup activities. Ayear later, I was one of 10 Red Cross volunteers pro-viding counseling to the flight survivors and theirfamilies during a private viewing, authorized by theNational Transportation Safety Board, of theburned, twisted remains of the plane.

Since then, I’ve become certified in areas such asdisaster health services, shelter operations, damageassessment, family services, and mass care. Whentornadoes hit central Arkansas in January 1999 andin April 2000, I served as a Red Cross nurse, assess-ing the health status of families living in the sheltersand determining the needs of those who were hos-pitalized. In December 2000 severe winter stormsblanketed much of Arkansas in ice, leaving somefamilies without electricity for as long as twomonths. As an expert in community nursing, Ianswered hotline calls, directing callers fromaround the state to community resources for foodand shelter. When the air conditioning system failedin a Little Rock high-rise building in the summer of2001, I helped open a shelter at the state fair-grounds for the elderly and disabled residents, whohad been enduring the 100°F-plus temperatures intheir apartments for three days, and monitored theirhealth status.

Since 2000 I’ve served as a camp nurse each sum-mer for a program called Rapid Response TeamTraining, in which students from high schoolsstatewide learn first aid and disaster response andleadership skills under the guidance of Red Crossstaff. The students return to their schools preparedto form teams capable of responding rapidly topotential natural and manmade disasters by provid-ing first aid while awaiting emergency personnel.The students are also taught to assess the safety of

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This “Safe Room” was the only part of this house left standing when the tornado rippedthrough this neighborhood in Alabama.