On a recent reconstruction trip, standing beside an open rectangle in the wooden frame of a Biloxi, Mississippi home, I listened as a seventy-year old homeowner pointed through the soon-to-be window and said, "You see that tree? We clung to it for hours. It saved our lives when the water got so high we had to swim off the roof." Now a full two years after the hurricane hit shore, I couldn't even begin to imagine the harrowing Katrina scene that this courageous grandmother described.

As images of indiscriminate destruction flashed across every TV news show in the country, nurses nationwide felt the call to respond. Hundreds of nurses offered their invaluable skills, time, and energy to countless homeless, hungry, and injured people in post-Katrina Louisiana and Mississippi. They cared for the aforementioned grandmother and her extended family for weeks after their home had literally washed away.

Disaster relief is a specialized branch of nursing. Organizations such as the American Red Cross excel in training qualified medical professionals in performing such often overwhelming and exhausting work. Disaster relief is like CPR. Once trained, nurses report a sense of obligation to assist at accident scenes or during emergencies. In the face of Katrina, a striking number noted a pressing awareness of duty, knowing that they could play a critical role. From all ends of the country, nurses juggling families and jobs left home with little time to prepare in order to be of service.

Hailing from forty-seven states, nurses flew or drove to impromptu shelters, "tent cities", and clinics set up in convention centers and roller rinks. Once there, they witnessed a state of alarming disarray. Nurses accustomed to working in 1:4 patient ratios per shift on specialized, high-tech hospital units were now triaging upwards of a hundred people in a day with only the most basic of medical supplies. The most pressing needs were generally not the most acute. Basic and essential patient interventions, the kind that nurses are especially equipped to manage, were in great demand. People needed showers, toilets, clean clothes. They need reassurance. They needed skilled listeners to take in their tales of loss and catastrophe. Hordes of suddenly homeless people had been without their anti-hypertensives, insulin, and psychiatric meds for days. Nurses took vital signs, histories, and lists of necessary medications before passing patients on for further care.

In reviewing the literature on the post-Katrina nursing response, many nurses cite the fact that the most useful task in these pseudo-clinics was perhaps the most simple - dispensing anti-bacterial hand gel. Containing disease-spreading microorganisms in compact, highly populated living quarters became a matter of public health necessity. Nurses directed the effort. They sat beside ailing family members so that able-bodied caretakers could bathe for the first time in days. They took note of the telltale symptoms of urinary tract infections in people without access to proper bathrooms. As adrenaline-charged feelings of fight-of-flight subsided and people settled into the reality of their ever-altered lives, Katrina survivors noticed, for the first time, lesions and injuries sustained during the evacuation effort. Open wounds had been exposure to flood waters infected by raw sewage. Nurses inspected swarms of people, one-by-one, scanning for injuries, cleaning and dressing wounds, and coordinating ongoing medical treatment.

There is no question, Hurricane Katrina, a natural disaster of immense proportions, taught the nation several unavoidable lessons about crisis management. It also illustrated, beyond question, the unique and invaluable contributions of nurses in disaster relief.

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