Australasian Emergency Nursing Journal (2006) 9, 171—178

Australian nurses volunteering for the

Sumatra-Andaman earthquake and tsunami of
2004: A review of experience and analysis of data
collected by the Tsunami Volunteer Hotline
P. Arbon a,∗, C. Bobrowski b, K. Zeitz c, C. Hooper d,
J. Williams e, J. Thitchener f

a School of Nursing and Midwifery, Flinders University, GPO Box 2100,

Adelaide 5001, South Australia, Australia
b Royal College of Nursing Australia, Australian Capital Territory, Australia
c St John Ambulance Australia, South Australia
d SMEC International, Australian Capital Territory, Australia
e St John of God Hospital, Subiaco, Western Australia, Australia
f Australian Volunteers International, Victoria, Australia

Received 17 February 2006; accepted 9 May 2006

KEYWORDS Summary This paper provides an outline of the work undertaken by nurses who
Emergency; participated in the relief effort as members of Australian medical teams during the
Disaster; Sumatra-Andaman earthquake and tsunami response. This profile is contrasted with
Tsunami; the information provided by nurses who registered their interest in volunteering to
Volunteering;
help via the Australian Tsunami Hotline. The paper provides an overview of the skills
and background of the nurses who provided information to the hotline and describes
Nurses
the range and extent of experience among this cohort of potential volunteers. This
data is compared to nursing workforce data and internal rates of volunteering in
Australia. The paper concludes that further research is necessary to examine the
motivations of and disincentives for nurses to volunteer for overseas (disaster) work
and, to develop an improved understanding within the discipline of the skills and
experience required of volunteer responders. Further, it is argued that the develop-
ment of standards for the collection of disaster health volunteer data would assist
future responses and provide better tools for developing an improved understanding
of disaster volunteering.
© 2006 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All
rights reserved.

∗ Corresponding author. Tel.: +61 8 8201 3558.

E-mail address: paul.arbon@flinders.edu.au (P. Arbon).

1574-6267/$ — see front matter © 2006 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.aenj.2006.05.003
172
Introduction
On the morning of 26 December 2004 an earth-
quake in the magnitude of 9.0 on the Richter scale
occurred off the west coast of the Indonesian
island of Sumatra. More than 11 countries were
affected by the quake and the resultant tsunami.
The death toll reached approximately 260,000
people and at least 1.7 million people were ren-
dered homeless. The event impacted upon many
nations surrounding the Indian Ocean and evoked
an extensive international humanitarian response.
The Australian Government’s reaction was prompt
with high-level Federal and State Government
committees meeting to determine the level and
type of response that would be required.1 Many
Australian individuals sought opportunities to
provide assistance to the devastated communities.
Various processes were activated to assist on
many different levels. The Australian Government
provided medical teams to several of the areas hit
hard by this disaster and established a free-call
Tsunami Hotline to deal with the many enquiries
various agencies were receiving.
This paper provides an outline of the work
undertaken by nurses who participated in the relief
effort as members of Australian medical teams
during this overseas disaster response. This profile
is contrasted with the information provided by
nurses who registered their interest in volunteering
to help via the Tsunami Hotline. The paper provides
an overview of the skills and background of the
nurses who provided information to the hotline
and describes the range and extent of experience
among this cohort of potential volunteers. This
data is compared to nursing workforce data and
internal rates of volunteering in Australia. The
paper concludes that further research is necessary
to examine the motivations of and disincentives
for nurses to volunteer for overseas (disaster)
work and, to develop an improved understanding
within the discipline of the skills and experience
required of volunteer responders. Further, it is
argued that the development of standards for the
collection of disaster health volunteer data would
assist future responses and provide better tools for
developing an improved understanding of disaster
volunteering.
The Australian response
The Australian Government response involved
deployment of civilian medical teams drawn from
State and Territory health departments and the
establishment of a Tsunami Hotline for individuals
P. Arbon et al.
wishing to volunteer to assist in the humanitarian
response.
Australian Government civilian medical teams
were comprised of emergency and operating the-
atre nurses, general and orthopaedic surgeons,
anaesthetists, emergency and public health physi-
cians and general practitioners. Ambulance and
fire service personnel provided logistical support
to each team. Teams were resourced through State
Disaster Plan arrangements and recruited personnel
with previous experience in responding to interna-
tional medical deployments.
Twenty-eight personnel in two teams (Team
Alpha and Team Bravo) were deployed on 29 Decem-
ber 2004 to fly to Banda Aceh, Indonesia. Medi-
cal and personnel supplies were provided by the
New South Wales (NSW) Department of Health and
the NSW Urban Search and Rescue Cache along
with equipment and aid supplied by the Australian
Defence Force (ADF).
Team Charlie, a 17-person team with a focus on
public and primary health care, was deployed to the
Maldives with logistical support from NSW Health
and the NSW Fire Brigade. This team departed Syd-
ney on 30 December and returned on 8 January
2005.
Team Delta was a five-person public health team.
This team was deployed on 30 December to Sri
Lanka to provide high-level support to the Sri
Lankan Government in the management of public
health issues arising from the disaster.
Team Echo was deployed directly from Adelaide
to Banda Aceh on 7 January. This team was predom-
inantly a surgical unit with a focus on reconstructive
surgery and infectious disease capabilities. A pub-
lic health component was included with diagnostic
facilities for disease monitoring.2
Team Foxtrot was deployed from Queensland on
18 January and was replaced by Team Golf from
Victoria on 29 January. Their roles and structure
changed progressively as the incident evolved from
an emphasis on surgical intervention to a focus on
public and primary health care.3
Banda Aceh was severely impacted by the earth-
quake and tsunami with large numbers of dead and
injured, and badly damaged infrastructure. Teams
Alpha and Bravo provided surgical and medical care
at an abandoned hospital in Banda Aceh as well
as supporting ADF medical teams at another hos-
pital in the city. They undertook over 90 surgical
procedures, saw over 300 patients per day and
managed approximately 70 inpatients in the hos-
pital each day.4 They saw patients with traumatic
injuries from the tsunami and earthquake as well
as medical problems such as salt-water aspiration.
The nursing members of these two teams were
Australian nurses volunteering for the Sumatra-Andaman earthquake and tsunami of 2004
predominantly from emergency nursing and oper-
ating theatre backgrounds. Nurse team members
carried out a variety of tasks ranging from direct
patient care, to logistical support and planning in
the difficult environment. The emergency nurses
reported working well outside their normal scope
of practice; having to improvise, carry out unfamil-
iar procedures and roles and care for patients that
they would rarely see in daily practice in Australia.
The team worked in challenging conditions, which
were compromised by multiple daily aftershocks,
which further damaged the working environment
and equipment.
Team Charlie, deployed to the Maldives, faced a
different scenario. The Maldives had suffered sig-
nificant damage but injuries and loss of life were
minimal. For the Maldives, critical issues arising
from the disaster were the loss of infrastructure
and the need to resume effective health support
to the many islands that make up this nation. The
Australian medical contingent, after initial consul-
tation with the Maldives Department of Health, was
split into four teams. These consisted of medical
practitioners, nurses and public health physicians.
Nursing members of the team were involved in
primary health care assessments, management of
simple medical problems, the provision of advice
to local health care workers and the formulation
of assessments and recommendations on key areas
where ongoing assistance would be needed. Med-
ical practitioners provided health assessment and
managed medical problems whilst the public health
physicians undertook detailed assessments of pub-
lic health issues including water supply, sanita-
tion, waste management and potential disease out-
breaks.
The Australian response focussed on the pro-
vision, in consultation, of health support to the
Indonesian, Sri Lankan and Maldives Governments.
Nurses on the initial teams were selected because
of their past experience or training in disaster
management. Senior nurses in the emergency and
perioperative specialties were identified as being
most suitable for the initial response although
the environments in which they would be working
were unknown and unpredictable. In review, the
Australian response, in the early stages of the
disaster, may have benefited from deployment
of more nurses with public health or community
health backgrounds.
Nurses in the deployed teams, as well as per-
forming clinical duties, also undertook a variety of
tasks such as providing leadership, medical logis-
tics, equipment acquisition and maintenance as
well as administration tasks such as ward and oper-
ating theatre management. Management of wards
173
involved coordination of family and lay carers as
well as effort to re-establish normal processes such
as infection control, waste management, clinic rou-
tines and follow up care.5 In Banda Aceh, some
nursing team members also supported the Aus-
tralian military medical response.
The Tsunami Hotline
In response to an increasing demand from the
public to volunteer, on 31 December 2004, For-
eign Minister Alexander Downer announced that
the Australian Government Agency for Interna-
tional Development, AusAID, in partnership with
Australian Volunteers International (AVI), had
established a Tsunami Hotline for people wishing
to volunteer their skills in response to the Indian
Ocean Tsunami. The free-call Tsunami Hotline was
developed to register people, including those with
nursing qualifications, who wanted to volunteer
assistance to the tsunami affected areas. Other
government agencies were also receiving calls
from potential volunteers, and in late January,
the Australian Government, asked AVI to manage
the volunteers who had registered with Centrelink
(1295 volunteers), Department of Foreign Affairs
and Trade, (DFAT) (200 volunteers) and Department
of Health and Ageing , (DoHA) (5260 volunteers) and
consolidate all the information into one tsunami
volunteer register with consistent data collection.
The hotline was advertised in the general press
and through professional organisations. During the
three month period that the hotline operated,
there were 10,393 calls to the centre.6 Volunteers’
details were collected in a central database includ-
ing qualifications, experience, clinical skills, emer-
gency management experience, language skills and
passport information. This information was then
available to be matched with the local health assis-
tance needs identified by affected countries. This
paper reports on data concerning nurse volunteers
that was identified and extracted from the Tsunami
Volunteer database before analysis by the authors.
The profile of nurse volunteers
Gender
The Tsunami Hotline received 3694 offers of assis-
tance from nursing and/or allied health care pro-
fessionals in the three month period of operation.
Nurses accounted for the overwhelming majority
of offers (99.7%: n = 3683) from nursing or allied
health professionals. More female nurses (87.4%)
174 P. Arbon et al.

Table 1 Proportion of nurses employed in each Australian State and Territory compared to proportion of nurses
volunteering to the hotline for each jurisdiction
NSW VIC QLD WA SA TAS ACT NT
Percent of Australian nurses employed (2003) 31.5 28 16.7 8.9 9 2.6 1.6 1.3
Percent of nurse volunteers by state 25 29 18 13 9.2 2 3 1

came forward than males (12.6%). However, when of callers had undertaken their nursing education in
this gender split is compared to the proportion of Australia. The majority of callers came from NSW
males overall in the nursing profession in Australia, (25%) and Victoria (29%) representing 54% of all calls
men are over represented in the volunteer group. received (See Table 1).
Figures for 2003 indicate that men constitute 8.6 When numbers of volunteers are examined as a
percent (%) of the nursing workforce nationally.7 proportion of the nurse population in each State
While nursing remains a female dominated profes- or Territory, Tasmanian nurses were more likely to
sion, the number and proportion of male nurses volunteer than their colleagues in the larger States
has been increasing in recent years. In the five (see Table 2).
year period from 1997 to 2003, the proportion of
male nurses increased by one percent (7.6—8.6%).7
Despite this gradual increase it is unlikely that an Age of nurse volunteers
increase in male numbers would account for the
The age range for potential volunteers was 18—78
proportion of calls received from male nurses to
years with the majority being in the 40—49 year
the Tsunami Hotline.
age group (29.2%). This group was followed by the
The term nurse is used here to refer to both a
30—39 year age group (22%) and the 50—59 year age
Registered Nurse (RN) and Enrolled Nurse (EN). In
group (19.7%) (Fig. 1). The age distribution mirrors
2003 there were more than three times as many
the national age structure of the nursing workforce.
RNs compared to ENs in the Australian health care
According to the Australian Institute of Health
industry. Of the 236,645 nurses employed nation-
and Welfare,7 the average age for all employed
ally, 189,071 were RNs and 47,574 were ENs.7
nurses was 43.1; 2.8 years older than in 1997.
The Australian Bureau of Statistics (ABS) con-
The proportion of nurses aged less than 35 years
ducted a Survey of Voluntary Work in 1995.8 Though
decreased from 29% in 1997 to 23% in 2003, while
this survey did not include overseas voluntary work,
the proportion of those aged 45 years or more
the results indicate that there is little difference in
increased from 33% in 1997 to 47% in 2003.7 Male
the numbers of men and women engaging in volun-
nurses are, on average, younger than female nurses
tary work in the general Australian population. The
with the average male age being 41.7 years and for
ABS8 found that 33% of women compared to 31%
female nurses 43.2 years .7
of men undertake voluntary work. Further, this was
In the general population, people aged 35—44
found to be the case regardless of birthplace, fam-
years reported the highest rate of volunteering
ily status, labour force status or location, with few
(40%) in 2000.9 This rate falls to approximately 33%
exceptions.8
in the 45—54 year age group.

Nursing volunteers by state of registration Previous disaster or military experience

More than 50% of the nurses who contacted the
Tsunami Hotline had registered to practice since
1990. Of that group, approximately half had reg-
istered since 2000. Unfortunately, this information
was not recorded for a large proportion of the
potential volunteers within the database. Over 75%
Callers to the Tsunami Hotline were also asked
if they had any previous experience of disaster
response work or military experience. Over 80% had
no such experience while 6.4% reported military
experience and 7.8% claimed they had worked in
disaster response (Fig. 2).

Table 2 Nurse volunteers as a proportion of State or Territory nurse population

NSW VIC QLD WA SA TAS ACT NT
Percent (%) 1.2 1.4 1.7 1.6 1.2 7.4 2.5 0.9
Australian nurses volunteering for the Sumatra-Andaman earthquake and tsunami of 2004 175

Figure 1 Age of callers (n = 3694).

Figure 2 Military or disaster experience (n = 1147).

Callers were asked if they had recently visited
one of the affected countries. The majority of
callers had not (85%). Of the 80 people who had vis-
ited an affected country, 20% had visited Indonesia
and 23% had been to India (see Fig. 3).
Callers were also asked whether they had any
language skills relating to the affected countries.
Of the 1351 callers asked this question, the major-
ity did not have relevant language skills (83.5%). Of
those who stated they did posses language skills,
7.6% stated they could communicate in Bahasa
Indonesia. However, many of the people who pos-
sessed language skills rated their language com-
petency as ‘basic’ (62%) with less than a quarter
regarding themselves as ‘fluent’. The balance of
those with language skills rated themselves as being
in the intermediate category (15%) (Fig. 4).
Preparedness to travel overseas
Information regarding immunisation status was also
collected from volunteer callers to the hotline.
Almost 40% of callers were unsure of their immu-
nisation status or required boosters. More than 25%

Figure 3 Which of the affected countries have you visited?

176
Figure 4 Language skills related to the affected areas (n = 223).
Figure 5 Immunisation status (n = 3694).
of callers had been immunised against Hepatitis B
(Fig. 5).
To be available for rapid deployment to the
disaster zone, a current Australian passport was
required. The majority of callers (73.3%) held cur-
rent Australian passports while 15% did not.
Volunteers were willing to make themselves
available for varied lengths of time. The majority
of people were able to commit for three months or
less (59.9%) while others indicated a desire to go
long ‘term’.
Discussion
The overall picture of nurse volunteering
The brief review provided here of the experience
of nurses who responded as part of Australian med-
ical teams to the earthquake and tsunami affected
area highlights some of the challenges facing vol-
unteer nurses in these situations. It is clear that
nurses responding to overseas disaster sites will
be required to work in difficult, disorganised and
poorly resourced situations where health services
are provided with whatever equipment and per-
sonnel are available. In this context nurses will be
exposed to injuries and illnesses that they rarely
encounter in Australian health care environments,
will have the traditional limits on their scope of
practice challenged and will be required to draw
P. Arbon et al.
not only on their clinical skills but also the rela-
tively unique skills of the nursing profession in the
re-establishment and management of health care
settings such as hospitals.
The development of a nursing response focussed
on the needs of affected areas rather than on
the availability of nurses and their individual skills
seems appropriate. For example, should the pri-
mary need involve re-building health services and
re-establishing care management a shift in empha-
sis from emergency care and theatre nursing to
primary health and health management may be
appropriate.
This paper contrasts the experience and skills
required of those nurses who did respond with the
profile of nurses who volunteered their assistance
to the Tsunami Hotline. Nurses volunteering to the
hotline were not required to respond as adequate
numbers of experienced nurses were resourced
through established Australian disaster arrange-
ments. Nonetheless, it is interesting to consider the
availability and willingness of nurses to volunteer
and to draw conclusions about their understand-
ing of the skills and experience that would prepare
them for such a deployment.
Are Australian nurses ready to respond?
It can be argued that the Tsunami Hotline was
established, at least in part, to manage the large
influx of offers of assistance from an Australian
Australian nurses volunteering for the Sumatra-Andaman earthquake and tsunami of 2004
community shocked by the extent and serious-
ness of the disaster. Many Australians from many
different backgrounds and vocations volunteered
their time through the hotline. It seems that rel-
atively few gave much thought to the practical
details associated with preparation for deploy-
ment and many appeared to be looking for a pos-
itive avenue through which they could make some
response.
Many of those nurses who volunteered (over 80%)
had no disaster or military experience. No informa-
tion was collected on disaster medicine education
though access to such training is very limited in Aus-
tralia. Few had visited the affected areas previously
or had language skills that might assist them in clin-
ical work. While all were willing to be deployed,
few had appropriate immunisation status, and many
(40%) were unsure of their status. Real availabil-
ity for deployment and the potential impact of
this on Australian health care venues could not be
assessed. This is a significant issue because there is
a workforce shortage of nurses throughout all States
and Territories currently.
It appears that programs to inform nurses about
education, speciality, immunisation and experience
that might be required in an overseas disaster
response would be a useful adjunct to existing off-
shore disaster response strategies within Australia.
This conclusion is supported by the experience of
Japanese nurses.10 Further development of disaster
nursing educational programs and efforts to embed
such education within existing professional degrees
would also be useful.
Are language skills a limitation for regional
response?
A large proportion of volunteers did not posses lan-
guage skills that might assist their clinical work
if they were deployed. The relative scarcity of
Asian language speakers within the profession is
a limitation for offshore disaster response in our
region.
Can nurses specialise in this area and what
education is required?
The significant number of nurses volunteering to the
Tsunami Hotline raises questions about the avail-
ability of disaster nursing education in Australia.
Many of these nurses appear to be, at least in this
cursory analysis, poorly prepared to respond to an
offshore disaster. Equally, even though factors such
as language and immunisation are relatively less
important, this group of volunteers have very lim-
ited experience and knowledge to respond to a
177
significant on-shore disaster. It is argued that the
impact of disasters worldwide is increasing11 and
that we are more likely than ever before to be con-
fronted with the need to provide nursing care to
people affected by disaster. An evaluation of exist-
ing Australian programs and the development of
new educational opportunities in disaster nursing
is appropriate.
Limitations
Interpretation of the data obtained from the
Tsunami Hotline has been limited because, for many
callers, several data fields were not completed. In
addition, the caller or the telephone operator could
interpret several of the data base fields in differ-
ent ways. For example, callers were asked for their
qualification and may have responded with their
academic qualification or area of nursing special-
isation. Similarly, questions about availability for
deployment assumed that nurses would be/could
be released from their current employment com-
mitments.
The data originally collected from the various
agencies (AVI, Centrelink, DoHA and DFAT) was sig-
nificantly different. In February 2005, AVI mailed
out a ‘‘Confirmation of Details’’ form to all reg-
istered volunteers to try to complete missing fields
and ensure consistency of data. Only 27.9% of regis-
tered volunteers returned completed forms to ver-
ify data. Call centre staff followed up with phone
calls (760 calls in February, 821 calls in March) to
volunteers in order to fill in the gaps, however there
were still significant gaps in data collection when
the call centre closed on 31 March 2005.
There are often problems in conducting sec-
ondary data analysis and there would be some ben-
efit in researchers and response agencies working
together to develop a minimum data set prior to
the next request for disaster volunteers. In this way
data fields that are considered useful for future
planning could be incorporated and standard ques-
tions developed to guide telephone operators. It
would also be useful to undertake the development
of a standard training program and guidelines for
telephone operators to increase the reliability of
the data collected.
Finally, the Tsunami Hotline database demon-
strates the difficulty of analysis when definitions
are unclear. Information in the database addressing
areas such as qualification, availability, education
level, area of practice and overseas experience are
difficult to interpret. For example, an individual
listed as a ‘nurse’ with a ‘certificate’ qualifica-
tion could be a Registered Nurse or an Enrolled
Nurse.
178
Conclusion
The Australian response demonstrated that nurses
responding to overseas disaster sites will, fre-
quently, be required to work in difficult, disorgan-
ised and poorly resourced situations where health
services are provided with limited equipment and
personnel. This requirement is contrasted with the
profile of nurses who volunteered to the Tsunami
Hotline.
Over the three month period of operation, the
Tsunami Hotline collated data on nurses willing to
volunteer and be deployed to the disaster affected
areas. Some differences in volunteering rates have
been noted and significant shortcomings in the level
of preparation of a high proportion of nurses who
put themselves forward to assist. This is not a crit-
icism of any individual volunteer but does raise
questions about the impact of current disaster nurs-
ing education and the level of understanding within
the nursing profession of the demands of providing
healthcare in a disaster affected area. In addition,
the willingness of nurses to volunteer deserves fur-
ther investigation to consider the motivations and
possible disincentives for nurses.
This paper concludes that a review of disaster
nursing education and the provision of information
about disaster nursing within the profession in Aus-
tralia is overdue. Further, it is noted that an oppor-
tunity exists for the development of a national min-
imum data set for health care volunteers that has
the potential to inform future responses to offshore
disasters. This data set should incorporate stan-
dard definitions and utilise guidelines, including set
questions, to ensure that data collected is reliable
and valid.
This manuscript has been peer reviewed.
Competing interests
None declared.
P. Arbon et al.
Funding
None declared.
References
1. Robertson, AG, Dwyer, DE, Leclercq, MG. Operation
South East Asia Tsunami Assist: an Australian team in the
Maldives. Accessed online 28th February 2005. http://
www.mja.com.au/public/issues/182 07 040405/rob10089
fm.html; 2005.
2. Grantham, H. Southeast Asian Tsunami—Australian ECHO
Team Response. Supplemental Abstracts for the Scientific
and Invited Papers, 14th World Congress for Disaster and
Emergency Medicine. 16—20 May, Edinburgh Scotland. Pre-
hosp Disaster Med 2005;20(2):s114.
3. Efstafis, V. Personal Communication. Brisbane, March 2005.
4. Cooper, DM. Operation Tsunami Assist: Australian civil-
ian medical team deployment. Supplemental Abstracts for
the Scientific and Invited Papers, 14th World Congress
for Disaster and Emergency Medicine. 16—20 May,
Edinburgh Scotland. Prehosp Disaster Med 2005;20(2):
s113—4.
5. Jongen, T, Boxshall, K. Personal Communication, Royal
Perth Hospital, August 2005.
6. Australian Government. Volunteer Your Services. Accessed
online 25th July 2005. http://www.tsunamiassist.gov.au/
how to help/volunteering.htm; 2005.
7. Australian Institute of Health and Welfare. Nursing and Mid-
wifery Labour Force 2003. National Health Labour force
Series Number 31. AIHW, Canberra; 2005.
8. Australian Bureau of Statistics. Voluntary Work Australia.
Catalogue number 444.1, ABS Canberra; 2001.
9. Australian Bureau of Statistics. Year Book Australia 2002:
Income and Welfare—Voluntary work in 2000. Accessed
online 8th November 2005. http://www.abs.gov.au/
Ausstats/abs@.nsf/; 2005.
10. Mitani S, Kuboyama K, Shirakawa T. Nursing in sudden onset
disasters: factors and information that affect participation.
Prehosp Disaster Med 2003;18(4):359—66.
11. Pan American Health Organisation. Why do natural dis-
asters seem to be increasingly frequent and increasingly
deadly? Accessed online 2 February 2006. http://www.
paho.org/English/DD/PIN/pr060109.htm; 2005.