Opinion: it is at a local and community level that the impact of climate change is most felt and especially when it comes to health

Climate change is the biggest threat to the future health, well-being and lives of humans on planet earth. A combination of rising temperatures plus extreme cold, rising sea levels, changing acidity of sea water, expanding areas of drought and associated crops failures makes response to climate change a priority for world governments. It is estimated by the World Food Programme that close to 375 million people are being impacted by climate change and most of the deaths that occur due to crisis, disasters or catastrophes world-wide can be linked to climate change. 

But it is at community level that the impact of climate change is most felt and especially when it comes to health. While flooding causes death, injury and population displacement, the increased risk of diseases such as Weil's disease and a variety of skin conditions as a result of contact with flood water must be considered. Equally serious are the risks associated with rising temperatures resulting in an increasing number of people suffering heat stroke. There is an increased prevalence of Lyme disease, especially in northern Europe as a result of ticks being able to move further north.

While communities can adapt to the demands of such crises, the area of mental health and recovery presents the biggest challenge. Displacement, loss of a home, livelihood and economic income is linked to increased levels of depression, post-traumatic stress and, in some cases, suicide. 

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Video from Ulster University's disaster training day 

Working in partnership with Derry City and Strabane District Council and emergency services, the School of Nursing at Ulster University hosts an annual conference and co-designs a major simulation that addresses the priorities for local communities. Final year nursing students study the effects of climate change on communities and are assessed on their ability to show leadership in community resilience. 

The nursing simulation involves over 500 participants and 14 different agencies and is the largest nursing simulation staged in Ireland. Evacuation of the old, disabled and those with chronic illnesses during flooding takes priority. Nurses must have up-to-date knowledge and skills in dealing with heat stroke. They must be proficient at providing evidence-based care such as tepid sponging, cold sheets supported by sips of fluid and electrolyte replacement. They must also desist from such obvious interventions as the use of a fan to cool an older person experiencing heat stroke or use of paracetamol, which can accelerate death. 

Weil's disease or leptospirosis is a condition caused by a bacterium carried in rats’ urine. During a flood situation when drains and sewers well-up, rats’ urine is always present and there is an increased risk of leptospirosis. It is critical that victims of flooding have an immediate opportunity to wash or most certainly remove wet clothing.

The emotional response to loss of a home, personal possessions and livelihood can be devastating and climate change brings such issues to the fore

If the skin is broken due to cuts and abrasions, prophylactic antibiotics are necessary. As flood water is always mixed with soil from fields and gardens the risk of tetanus is high. Administration of a tetanus vaccine is important. Other non-specific skin reactions such as rashes can be treated with immediate removal of wet clothing and washing.

Because clean water can be in short supply during a flood, this requires creative thinking. The nurses work closely with community leaders who are experienced in running community centres during a flood response. Community leaders are involved in the assessment where the nurses are required to set up a simulated community centre for flood response and manage the associated injuries and public health requirements. 

The emotional response to loss of a home, displacement, loss of personal possessions and livelihood can be devastating and climate change brings such issues to the fore. Mental health first aid is so important in such emergencies. Nursing students receive advice from experts on the use of mental health first aid, helping people to reconnect with family and friends and begin the process of adapting to loss. Experts in refugee health help them empathise with those people who are displaced.

The use of simulations based on real community concerns means that the nurses of the future have a sound base for being future leaders

During the simulated events, students get an opportunity to respond to real life events, based on the experience of members of the public. In the days and weeks that follow, people need time and space to talk about their experiences. If there is risk of suicide, this also must be managed in a sensitive and caring way. Agencies who work in suicide prevention are involved in the assessment of nursing students. All this can have a big impact on the health professional so the nursing students get support and advice on personal coping, resilience and debriefing. 

Climate change is something that all citizens must address. Health and healthcare will be impacted, so nurses have a key leadership role both as citizens and professionals. The use of assessed simulations that are based on real community concerns means that the nurses of the future have a sound base for being the future leaders in assisting communities develop resilience in the face of climate change.

The views expressed here are those of the author and do not represent or reflect the views of RTÉ